Table of Contents
I. Snapshot of the Federal Research Portfolio
II. Gaps in the Knowledge Base: Examples of Research
III. A Key Element of the Research Enterprise: Links to Policy Makers and Service Providers
IV. Next Steps: Options for Phase Two of the Children's Initiative
Appendix A: Subcommittee on the Children's Initiative
Appendix B: Methodology
Appendix C: Selected Bibliography
Appendix D: Examples of Successful Research-Policy or Research-Services Linkages Submitted by Agencies
Preparing America's children for the 21st century is among our most
important national priorities. Today's children face the promise of
a new century of unparalleled opportunity in which new technologies,
improvements in health, expanding economies, and other advances
create the hope that their future will be the brightest of any
generation in history. Yet, too many of them face obstacles that
obscure that bright future, including poverty, violence, child abuse,
limited educational opportunity, and unhealthy behaviors. The
devastating economic, social, and human costs of these obstacles are
indisputable. Addressing these challenges to their future and
investing in opportunities so that all children can reach their full
potential is a high priority of the Clinton Administration.
An essential component of this strategy is undertaking research to
provide new knowledge of ways to improve their futures and to
provide sound guidance for policy makers to assure that efforts
to help are likely to succeed.
Numerous indicators of the well-being of our children and families
paint a mixed picture of successes and shortcomings. Our
national infant mortality rate is declining rapidly and is at a
record low, but is still higher than that of many other countries.
Our children's test scores in reading and science are improving
but still trail those of several other industrialized nations. Our
school dropout rate is unacceptably high, costing over $250 billion
each year in lost earnings and foregone taxes, as well as lost human
potential. Our teenage pregnancy rate is declining slightly,
but is still the highest in the developed world. Our national
vaccination coverage is the highest ever, but in many communities
less than 50 percent of two-year-olds are adequately immunized.
A similar picture of gains and unmet goals exists with respect
to youth violence, child poverty, smoking, and other substance abuse.
Much of the progress achieved in these and other areas is the result of
critical research efforts that have advanced our understanding of how
children and youths develop into healthy and productive individuals.
Research has helped to inform policy decis ions and program
development, track outcomes, and identify strategies that work and
those that do not. The Federal investment in research has clearly
paid dividends in terms of improved outcomes for children and a
healthier and brighter outlook for the entire Nation. Despite
such important achievements, much remains to be done:
Significant gaps persist in our understanding of how
children grow up to be healthy, well-educated, and responsible members
of society. Given the profoundly changing nature of our communities
and Nation, strengthening the Federal research enterprise on child and
adolescent development and expanding its role in shaping relevant
policy are especially crucial to serving national goals.
The Children's Initiative Subcommittee
In May 1996, the National Science and Technology Council's
(NSTC) Committee on Fundamental Science and Committee on Health,
Safety, and Food formed the Children's Initiative Subcommittee to
explore the Federal investment in research focused on the biological,
cognitive, and social development of America's children.
Representatives from 23 Federal agencies involved in child and
adolescent research programs came together to examine the Federal
investment in this area and to foster coordinated efforts. The
major goals of the Subcommittee were to:
- Assess the size and scope of the Federal research portfolio
on children and adolescents;
- Identify important research issues in children?s biological,
cognitive, and social development; and
- Strengthen research-policy linkages and develop a
sustainable process for collaboration and communication of
scientific knowledge about childhood and adolescence within
the Federal Government.
The Federal Research Portfolio
In fiscal year 1995, all levels of government combined spent an
estimated $500 billion on children and adolescents, almost two-thirds of
which was devoted to K-16 education. Most of the remaining funds were
allocated for social welfare (including Aid to Families with Dependent
Children (AFDC), Medicaid, Head Start, the U.S. Department of
Agriculture's (USDA) Special Supplemental Food Program for Women,
Infants, and Children (WIC), and the Food Stamp program), criminal
justice (including police, courts, and prison expenditures), health
care, and other programmatic expenses. Of this amount, approximately
$2 billion, representing less than four-tenths of one percent of the
total governmental expenditures on children and youth, was spent on
research and development. The estimated $2 billion investment,
less than three percent of the total Federal research enterprise,
is aimed at understanding the growth and development of 30 percent
of the Nation's population -- over 80 million children and adolescents
under age 21. In contrast to other areas where non-government sources
provide the larger share of the investment in research, the Federal
investment represents most of the research targeted toward children:
private foundations add approximately $75 million to the total, and
State and local governments a somewhat larger amount. These
comparisons call into question whether the current Federal research
investment related to child and adolescent health and development is
consistent with Federal investments in research in other areas, and
whether it is adequate to meet the need for informed policies and
Important Research Issues and Opportunities
Although a great deal of knowledge about young people has been gained
from past research in the social, behavioral, and life sciences, we
clearly need to advance our understanding of what enables all
children to grow up to be healthy and active members of society.
As general themes, this research should focus on developmental
processes beginning before birth and extending through adolescence;
should address the relationships among biological, cognitive, social,
and emotional aspects of development; should include racial and ethnic
minority and non-minority groups and address influences of families,
peers, schools, communities, media, and other social institutions on
development; and should address enhancing positive outcomes rather
than just treating negative ones. Within these themes, six examples
of particularly important research opportunities were identified.
- Health and Behavior. With increasing recognition
of the major impact of behavior on health, important research questions
include what influences children to avoid or engage in risky and adverse
behaviors, the nature of the health behavioral change process for
children and youth, the cumulative effects of adverse and risky
behaviors on child development, age group differences in health risk
behaviors, influences of family and situational factors on health risk
behaviors, how children and adolescents perceive the risks of
engaging in health compromising behaviors, and what approaches would
help them adopt health enhancing behaviors.
- Children and Environmental Hazards. With children
facing a wide array of environmental threats to their health, it is
important to learn how best to understand the health implications
of these threats, understand the cumulative effects of hazardous
substances, identify hazards that are particular threats to children,
and learn when children are most vulnerable to these hazards.
- Learning. New knowledge about the brain processes
involved in learning provides opportunities to study the relationships
between learning and intelligence and creativity, the use of
technology to nurture the ability of children to learn and create,
the effects of multimedia technologies on children's development,
and the role of nutrition in influencing ability to learn.
- Influence of Families and Communities on Development.
Important questions include how children and families access community
resources and find out about their availability, how communities can
facilitate an adolescent's safe passage to adulthood, how changing
families and communities are affecting children and adolescents, and
how families and communities as well as children are being affected
by major policy innovations taking place at all levels of government.
- Longitudinal Studies. Long-term follow-up studies of
children provide the best means for assessing how child development in
"normal" conditions compares to what occurs in adverse conditions, how
families and social institutions can help children become economically
productive adults, how childhood experiences affect later adult behavior
and risks of chronic disease, and how childhood and adolescent
interventions can be most effectively targeted to the childhood
antecedents of adult disease to prevent or delay onset of problems
in adult life. To achieve the latter objective, studies could
address interventions during childhood to reduce the likelihood of
osteoporosis, cardiovascular disease, obesity, injury, smoking,
mental health problems, learning disabilities, AIDS, and other
- Policy Research. In this emerging field of research,
important questions to address are the effects of variations in health
care and welfare reform on children and families, the combined effect
of policy changes on child well-being and service delivery, approaches
to prevention and intervention that best foster health and well-being
of children, and data sources needed to monitor change.
Linking Research to Policymakers and
Knowledge gained through research on children can and should inform and
facilitate action to solve our Nation's urgent and costly social and
economic problems. But for Federal research to be used more
effectively in policy and program development, researchers must
improve the ways in which they communicate and disseminate important
findings to decision-makers. The scientific research community must
work to establish new links and strengthen existing ones with
policymakers and service providers. Likewise, policymakers and
service providers, for their part, must not only assist researchers
to identify key research questions concerning children, youth,
and families, but also must take responsibility for acting on relevant
research findings. When successful, such connections can have powerful
and beneficial results on children's well-being.
Given the complexity of influences on child and adolescent development,
improved connections between researchers and those who develop policies
and programs concerning the future of young people must be an essential
part of the Federal research strategy. These connections should be
thought of in terms of a continuing feedback system, with multiple
entry points for feedback and modification in the decisionmaking
process at the Federal, State, and local levels.
Such a strategy would enable researchers not only to inform initial
policy and program development, but also to monitor and evaluate the
implementation of these policies and programs -- and their effects on
child, adolescent, and family status -- on an ongoing basis. Sustained
research could provide knowledge that is essential in our effort to
further shape and refine policies and programs so that they more
effectively address the problems facing our children and Nation.
Increased multi-agency collaboration and coordination of research
on national priorities related to children's health, education, and
well-being are essential steppingstones to success. Just as
linkages should cut across public and private sectors and span all
governmental levels, the Federal Government's collaborative approach
should also strive to tap the knowledge and experiences of the private
sector, including foundations and private industry. Strategic
partnerships with interested public and private sources will be
instrumental to addressing the current and emerging needs for relevant
data and knowledge concerning children and adolescents.
A specific linkage issue is how the Federal research investment in
child and adolescent development can be more effectively used to
inform our Nation's domestic policy. Two fundamental questions are
involved. The first is how to create and strengthen the linkage
between two key councils within the Executive Office of the
President -- the National Science and Technology Council (NSTC) (which
coordinates the diverse parts of the Federal research and development
enterprise) and the Domestic Policy Council (DPC) (which oversees the
development and implementation of the President's domestic policy
agenda), in a way that fosters important research and uses the results
of that research to guide policy development. The second is how to
use this linkage between NSTC and DPC to create effective
collaboration among Federal agencies that support research on
children and adolescents.
Recommendations for Next Steps
To meet this challenge, the Children's Initiative Subcommittee
recommends that an Interagency Working Group (IWG), such as the
Task Force established in the Executive Order Protection of
Children from Environmental Health Risks and Safety Risks, identify
activities within their research portfolios that support, inform, and
facilitate the achievement of the Administration's key goals of
ensuring the optimal health, education, and well-being of all
American children and youth. The IWG's responsibilities should
include, but not be limited to, the following:
- Provide directly to the NSTC and DPC on an ongoing
basis -- the results of Federal research activities that
relate to these goals and have implications for policy.
- Develop and implement a long-term strategic planning
process -- to advance a multi-agency Federal R&D effort
related to the optimal development of children and adolescents.
This process should include the identification and recommendation
of appropriate partnerships among public and private sector parties
interested in ensuring the healthy and productive development of
children and adolescents.
- Identify key research investment opportunities regarding
children and adolescents -- to achieve the overarching goals
outlined in the strategic plan. These investment opportunities
should highlight the need for and the benefits of a multi-agency,
coordinated approach to scientific research concerning young people.
The Office of Science and Technology Policy (OSTP) and the Office of
Management and Budget (OMB) would play an integral role in working
with the IWG to develop a coordinated strategy, including budgetary
issues, in which agencies can collaborate on research problems of
national concern. These problems include strengthening the
collection of reliable indicators of child and adolescent well-being
and the research that provides us with knowledge of the factors that
influence these indicators over time. A coordinated research
strategy on optimal human development from early childhood into
young adulthood, particularly on factors supporting learning, should
be a high priority.
- Identify mechanisms to strengthen research-policy
linkages -- not only among NSTC, DPC, Federal agencies and
State and local government, but also among relevant non-governmental
organizations and other public and private sector parties at the
national, regional, and community levels. Such extensive linkages
are needed to ensure that research knowledge generated by Federal
agencies and other entities are effectively used to inform policy
and program development regarding children, youth, and families.
- Consider appropriate means for conducting an external
assessment of the IWG's work -- to ensure that the Federal
Government's strategic plan and identification of key research
investment opportunities, potential important partnerships, and
mechanisms for strengthening research-policy linkages regarding
children and adolescents are on target and effective.
Our Nation has a clear stake in ensuring that all of America's
children grow up to be healthy, educated, productive, and contributing
adults. Doing so requires removing barriers to achieving their
full potential, including the barrier of insufficient knowledge.
Scientific research is and will continue to be a catalyst for
achieving that goal; it serves as a fundamental tool to gain
knowledge needed for informing, developing, implementing, and
refining policies and programs that address the urgent needs of
children and adolescents. As such, research must be at the
forefront of the highest level of decisionmaking. The Federal
Government is faced with an opportunity to embark on a path that
will lead to creating and sustaining conditions that optimize
human development. It is time to take that first step -- to
establish a coordinated multi-agency research approach that
emphasizes partnerships among the public and private sectors and
linkages between the research and policymaking communities. We
owe our children, our families, and our Nation nothing less than
this sound investment in our future.
Preparing America's children for the 21st century is one of the top
priorities of President Clinton's second administration. Children
growing up in America today face the promise of a new century of
unparalleled opportunity in which new technologies, improvements in
health, expanding economies, broader educational opportunity, and
other advancements create hope that their future will be the brightest
of any generation in history.
At the same time, too many of our children, adolescents, and their
families face obstacles that obscure that bright future, including
poverty, violence, child abuse, inadequate education, and substance
abuse. Addressing these challenges to their future and investing in
opportunities to ensure that all children reach their full potential
is a central priority of the Administration. The devastating economic
and social costs of not responding to these challenges for both
individuals and society are indisputable.
The Administration's commitment to children and youth was demonstrated
in its first term. It launched a number of initiatives critical to
children and youth, including increasing Head Start enrollment by
almost 200,000 in 1997, curbing the sales and marketing of tobacco to
children (the Children's Tobacco Initiative); reducing teen pregnancy
rates; providing safer food and drinking water; and expanding
opportunities for children to improve their skills, maximize their
potential, and prepare for the 21st century workplace (the Educational
Technology Initiative, the America Reads Initiative).
Due in part to these efforts and the President's commitment to
"cherish our children and strengthen the American family," the Nation
has taken some modest but significant steps toward addressing these
daunting challenges. Progress in these areas must often be measured
incrementally. Solutions and knowledge of their effects and influence
often take years or even generations to emerge. Still, it is important
to acknowledge our successes. For example:
Mortality2||What We Have Accomplished:
||The infant mortality rate reached a record low of
7.5 infant deaths per 1,000 live births in 1995, a 6 percent decrease
from the previous year.
|Challenges that Remain:
||The U.S. still has one of the highest infant
mortality rates of any developed country; in some urban areas it
exceeds some developing countries. From 1985 to 1994, the rate of
low birth weight babies steadily increased. Low birth weight infants
account for nearly two-thirds of all deaths under 28 days of
age; those babies who survive are at increased risk of suffering
severe physical and developmental complications.|
|What We Have Accomplished:
||American fourth graders outperformed students from all
other nations, except Finland, in the latest International Assessment
of Reading, while American eighth graders have demonstrated
rising math and science scores in recent years. |
|Challenges that Remain:
||Despite our national goal of being first in the
world in math and science by the year 2000, U.S. eighth graders
scored below the average of 41 countries in the math portion of the
1995 Third International Mathematics and Science Study (TIMSS). In
science, students in nine countries outperformed U.S. eighth
graders. In 1994, 40 percent of fourth graders failed to attain
the basic reading level, while 70 percent did not attain the
proficient level (i.e., competency with challenging reading
materials). Poor reading performance is an important predictor
of school dropout. Each year's class of dropouts will, over the
course of its lifetime, cost the Nation about $260 billion in lost
earnings and foregone taxes, in additional to lost human
|What We Have Accomplished:
||The teen birth rate declined in 1995 for the fourth
straight year, while the unmarried birth rate has decreased for the
first time in nearly two decades.|
|Challenges that Remain:
||The teen birth rate is still higher than it was
20 years ago and the U.S. rate remains the highest in the developed
world. Every year about one million adolescents become pregnant,
most of whom are unmarried teens.|
|What We Have Accomplished:
||In 1995, three-quarters of all two-year-olds were
fully immunized -- a historic high. The incidences of Haemophilus
influenzae type b invasive disease, symptomatic hepatitis B,
and measles among infants in the highest-incidence groups
have been reduced by over 95 percent. |
|Challenges that Remain:
||Vaccine coverage among the economically disadvantaged
in inner-city areas is about 50 percent. Public health measures
require an immunization rate of 80 to 90 percent of all children
to prevent the spread of outbreaks.|
One of the greatest public health success stories
for children is development of vaccines against the infectious diseases
of childhood. Work continues today to develop more vaccines and assure
that they are used for maximum benefit.
NIH- and FDA-supported research has led to the creation of important
vaccinations that have been instrumental in reducing childhood illness.
For example, Hemophilus influenza type b meningitis used to infect
15,000 children yearly, and was the leading cause of acquired mental
retardation in the United States. The vaccine these agencies developed
has nearly eliminated the disease in just six years.
NIH serves as the lead agency within the Public Health Service on the
Children's Vaccine Initiative, a global effort launched in 1990 to
accelerate the development of safe, inexpensive, orally administered
vaccines. Work is under way on redesigning existing vaccines and
developing new vaccines against rotavirus diarrhea, pneumococcus,
meningococcus, Shigella dysentery, and other diseases.
CDC research showed that linking immunization services with WIC clinics
could significantly increase immunization coverage of low-income
children. In 1994, CDC and USDA developed a coordinated strategic plan
to improve the immunization and general health status of WIC
participants under two years of age. CDC also helped to develop
immunization registries, a critical tool to achieve the National Goal
for the Year 2000 of having at least 90 percent of two-year-old children
fully up-to-date with their recommended immunizations. These and
related efforts have brought us to the highest levels of immunization of
children in the Nation's history.
|Youth Violence6||What We Have Accomplished:
||The juvenile crime arrest rate decreased approximately 3 percent in 1995, while the juvenile murder arrest rate dropped more than 15 percent, marking the largest one-year decrease in
more than a decade.
|Challenges that Remain:
||Our Nation can do better. In 1995, the cost of
maintaining our prison system reached about $50 billion; in some
States, prison system costs exceed the cost of supporting the State's
higher education system. It is less costly to educate than to
|What We Have Accomplished:
||Since 1993, the child poverty rate has declined from
approximately 23 percent to 21 percent - the biggest two-year
drop since 1968. And with the recently passed Personal
Responsibility and Work Opportunity Reconciliation Act of
1996, the stage is set for a fundamental reconstruction of the
welfare system, giving States increased flexibility to move
families off welfare.|
|Challenges that Remain:
||Much more progress is needed to reduce poverty and
its short- and long-term impacts. Children living in poverty more
often are inadequately nourished, live in overcrowded and unsafe
environments, and experience academic underachievement, violence,
and greater unemployment of adult family members.|
|OVERCOMING ADVERSITY: IT CAN BE DONE8|
An alarmingly high number of children live in poverty, come from fragile families, and are exposed to violence and other adverse circumstances. Despite such obstacles, many go on to become healthy, well-adjusted, productive adults. What enables some chi
ldren to flourish in the face of
adversity, while others experience significant setbacks?
A three-decade, continuing longitudinal study of all children born on the island of Kauai, Hawaii, provides important insights into what makes
children resilient in the face of adverse conditions they experience
while growing up. Of the children designated as "high risk" because
they were born into chronic poverty, had experienced perinatal stress,
and lived in families plagued by conflict, divorce, alcoholism, or
mental disorders, one-third did not develop problems during childhood
or adolescence. This "vulnerable, but resilient" group of children
emerged as competent young adults who were gainfully employed, involved
in stable relationships, and active in their communities.
Three clusters of protective factors distinguished this group from
the other two-thirds who did develop problems by adolescence. The
results of the Kauai study and more than 250 other studies of
children growing up in adverse circumstances present a consistent
picture of the common factors that enable young people to beat the odds:
- Temperamental characteristics and social skills, which
involve family members and others, and at least average intelligence. Individuals who achieve social competence, including life skills,
are much more likely to flourish as adults, regardless of the conditions
in which they grew up. More children, especially those in high-risk situations, must be provided with various opportunities to develop
the competence and skills they need to succeed.
- Strong attachments with parents or parental substitutes,
including grandparents, kin, and siblings. The commitment of
nurturing, competent adults is crucial in a child's life. This
has important implications not only for the role that mentors, tutors
and other adults can play in helping shape the successful development
of children and adolescents, but also for efforts to increase
opportunities for young people to develop close relationships with
- A vital community support system such as a church, youth group,
or school that offers stable support and consistent guidance.
Community and social institutions have a special opportunity to help
children and youth foster healthy lifestyles. Yet, for many young
people, these kinds of support systems simply do not exist in their neighborhoods; even those who do have access to such institutions
often feel alienated or disconnected from them. More needs to be
learned about how to tap the underlying potential of community
institutions and how they can be more supportive of children and
|Smoking and Substance Abuse9|
|What We Have Accomplished:
|| Beginning in the early 1980s, the number of teens who smoked, used marijuana, or consumed alcohol declined or remained flat
- for about a decade.|
|Challenges that Remain:
||While use has not returned to peak levels of the
1970s, teenage tobacco and drug use has continued to climb over the
last several years, and alcohol use remains unacceptably high.
More than five million of today's underage smokers will
eventually die because of tobacco-related illnesses and if
current patterns of teen smoking persist, their health needs will
cost about $200 billion in health care alone. Alcohol and drug
use is a major factor in injuries - in particular, motor vehicle
injuries, which are the leading cause of death for persons every
age from 6 to 27 years, again exceeding rates for every other
|What We Have Accomplished:
||Young drivers age 15 to 20 have historically
represented a high risk group, involved in more fatal crashes per
licensed driver than drivers of any other age group. Alcohol has
been a major factor in these fatal crashes. Efforts to reduce the
alcohol-related fatal crash rate for young drivers have proven
successful: from 1982 through 1995 these fatalities for young
drivers declined by 59 percent, while adult alcohol-related
fatalities dropped by 28 percent. |
|Challenges that Remain:
||While this is good news, other reports are disturbing.
How long can this decline continue when drinking and drug use are
on the rise? Even if the current rate holds, population increases
among adolescent drivers will mean increased fatalities in
coming years. Zero tolerance laws for underage drinking
drivers and more active enforcement of underage drinking laws
are essential. We need to support efforts by various sectors of
the community and young people themselves to curb underage
drinking and impaired driving.|
Much of the progress achieved in these and other areas is grounded in critical research efforts that have advanced our understanding of how children and youth grow into healthy and productive adults. Research
has helped to inform policy decisions and program development,
track outcomes, and identify strategies that work and those that do
not. The Federal investment in research has clearly paid dividends in
terms of improved outcomes for children and a healthier and brighter
outlook for the Nation as a whole.
Consider, as examples, the pivotal role research has played in the development of early childhood education, the reduction and prevention
of childhood lead exposure, the reduction and prevention of childhood injuries and iron deficiency anemia, the identification of protective
factors that help children overcome adverse conditions such as poverty,
and the understanding of how child nutrition contributes to health and educational attainment (see box).
|EARLY CHILDHOOD PROGRAMS: THEY CAN MAKE A DIFFERENCE10|
Each day, some 13 million children attend early childhood programs
such as preschool, Head Start, pre-kindergarten, nursery school, and
child care programs. The role of children's experiences in these
programs in shaping their developmental outcomes can no longer be
ignored. The long-term prospects for most children depend to a great
extent on what happens to them during the children early years.
For three decades, researchers have documented the many practices
that have been shown to foster learning among children. Research on experimental early childhood programs in the early 1960s, followed
by Head Start in the mid-1960s, led to increased public understanding
about the importance of such programs. As the research body of
knowledge grew, so did evidence showing that quality early childhood
programs result in long-term educational and economic gains - including higher reading scores, reduced likelihood of being held back a grade
or placed in special education, increased chances of graduating from
high school and likelihood for employment.
Since the 1960s, research in the developmental neurosciences has
produced compelling evidence of the importance of the first three
years on brain development. Research indicates that a child's
social and cultural environment affects not only the number of brain
cells and connections among them, but also the way these connections
are "wired." Scientific findings document the positive impacts of
being raised in a healthy, caring, nurturing environment, as well as
the negative impacts of inadequate stimulation and impoverished
The Ypsilanti Perry Preschool Project of High/Scope, a well-known longitudinal study of low-income, African American children enrolled
in preschool, reported significant short- and long-term gains in
the children's school achievement, health, social adjustment and
economic prospects. The study, which began in 1962 and continued
into 1996, concluded that a high-quality preschool program creates
the foundation for adult success. A solid body of similar
longitudinal research on high-quality early childhood programs for
low-income children in different parts of the country supports
Recognition of the school readiness and possible longer term
benefits that good early childhood experiences can provide to
youngsters has prompted a growing public investment in early
childhood programs. Today, State and Federal Governments invest
about $10 billion annually in early childhood programs. Still,
less than half of all three- to five-year-olds with family incomes
of $40,000 or under were enrolled in preschool in 1995, compared
with 82 percent of children from families whose annual incomes were
more than $75,000.
Since most of these studies began in the 1960s and 1970s, what
remains to be seen is whether such programs can still produce similar advantages for today's young people, given the changing nature
of families and communities. Continued research on the impact of
early childhood programs is needed to advance our understanding of
the long-term outcomes.
Despite such important achievements, the Federal emphasis on research
must be sustained. There continue to be significant gaps in our understanding of how children grow up to be healthy, well-educated,
and responsible members of their communities and nation. Coordination
across the Federal Government as well as among Federal, State, and
local governments needs to be improved. Linkages between researchers
and policymakers must be strengthened. And changes in policy must be informed by policy-relevant research and assessments. These
challenges must be addressed if our Nation is to develop policies
and programs that meet the complex needs of today's children and youth. Strengthening the Federal research enterprise on child and adolescent development and its role in shaping relevant policy is especially
crucial given the changing nature of our communities and Nation.
The United States is experiencing significant changes in the racial
and ethnic diversity of its population, fundamental shifts in the
structure of families, and an increasingly global economy that
demands a highly skilled workforce to achieve an adequate standard
of living. At the same time, our society is undergoing changes in longstanding social policies; these changes include the devolution of responsibility for income support programs (e.g., welfare) from
Federal to State Governments and the restructuring of our health care financing system. Our Nation has learned how to invest in and profit
from research; now we must extend those efforts to meet the
challenges of the next century.
Maximizing the Nation's Investment:
Those who shape our Nation's policies and programs related to children, youth, and families are searching to find ways by which all of America's children can achieve their full promise. Conducting research is a
critical step toward increasing our knowledge of child and adolescent
development; such knowledge can inform and facilitate action to solve
our Nation's urgent and costly social and economic problems. Yet the information gained through research efforts must be integrated into
policy development to enable our society to address its difficult
Essential Research-Policy Linkages
To achieve meaningful progress, research on children and adolescents
must be used more effectively to inform our Nation's domestic
policymakers. This means the scientific community must better
communicate and disseminate significant research findings to
policymakers. Policymakers, too, must work with researchers to help
identify key questions concerning children, youth, and families that
need to be addressed through research.
Understanding the forces that shape young people's development and
using that knowledge to influence public policy and service delivery
should be a cornerstone of the Federal Government's research
enterprise. An example of the successful potential of this process
is described in the box in this section. To neglect this fundamental building block risks compromising national goals of security,
economic prosperity, and high quality of life for all.
|THE UNITED STATES EXPERIENCES DRAMATIC DECLINES |
IN CHILDHOOD IRON DEFICIENCY ANEMIA11
Iron deficiency, a widely prevalent condition in America that causes
anemia, has serious effects on the health and development of infants
and children. Infants with iron deficiency anemia have been shown to
score lower on tests of mental and motor development than their
healthy counterparts. Evidence also points to long-term effects of
iron deficiency at young ages including impairment in general
intelligence, language capability, fine and gross motor skills,
and visual integration.
Public policy efforts to reduce iron deficiency date back to the
1940s, when the NAS endorsed the addition of iron to white flour and
the Food and Drug Administration (FDA) established Standards of
Identity for enriched flour. By 1990, 95 percent of grain products
in the food supply were enriched, contributing to a 50 percent
increase in per capita consumption of iron.
Food assistance programs directed toward specific populations have
also succeeded in improving the iron status of these groups. The
USDA's WIC program, established in the early 1970s, is especially
noteworthy. WIC provides highly nutritious, iron-fortified food to
low-income women who are pregnant or breast-feeding and to their
children up to the age of five. The program also provides nutrition education and increased access to other health care and social
services, including prenatal care. One of the goals of the WIC
program is to reduce the incidence of iron deficiency among this
Research shows that the overall prevalence of anemia in children
from low-income families who participated in WIC declined from 8
percent in 1975 to about 3 percent in 1985. Among inner-city infants
who were given an iron-fortified formula during the first year of
life, only 1 percent suffered from iron deficiency anemia as
compared to about 9 percent of infants who did not receive an
Despite these improvements, iron deficiency anemia in infants and
children remains a public health concern. To assure the health and
well-being of America's children and infants, continued monitoring of
iron levels as well as dietary interventions are needed.
About This Report
This report, coordinated by the NSTC (see "About the Children's
Initiative" box), provides starting points for the Federal Government
over the next few years as it evaluates the research investments to
be made on key issues affecting the health, education, and well-being
of children and youth. This report also makes cases for strengthening
the use of research findings to inform policy and program development
and for establishing productive partnerships among public and
private sectors. Taken together, the steps recommended in this
report should leverage the Federal investment in scientific research on children and youth, and the enhanced effectiveness of the policy
While Investing in Our Future: A National Research Initiative for America's Children for the 21st Century provides several examples of important research issues concerning children and
adolescents, a dynamic research framework and agenda is needed that would involve
partnerships among research and policy groups in the Federal Government, in collaboration with
non-governmental researchers and practitioners. This report should be considered the first phase
of a sustained effort directed towards that end.
Organization of Report
This report is organized into four sections. Section I is a Snapshot of the Federal Research Portfolio, which briefly describes the current Federal investment in research on children and
adolescents. The purpose of this assessment of activities is to provide the basis for identifying
gaps (Section II) in knowledge and Federal research investment.
Section II, Gaps in the Knowledge Base: Examples of Research Opportunities, provides examples of research needs in understanding children's biological, cognitive, and social
development, and a basis for establishing research priorities.
Next, Section III, A Key Element of the Research Enterprise: Links to Policymakers and Service Providers, discusses the need for establishing stronger links among researchers, policymakers,
and service providers to develop policies and programs that meet the needs of children and adolescents.
The report concludes with Section IV, Next Steps: Options for Phase
Two of the Children's Initiative, which provides recommendations for building on the work of this first phase.
|ABOUT THE CHILDREN'S INITIATIVE SUBCOMMITTEE|
In May 1996, the NSTC's Committee on Fundamental Science and
Committee on Health, Safety, and Food formed the Children's Initiative Subcommittee to explore the Federal investment in research focused on
the biological, cognitive, and social development of America's
children. Representatives from 23 Federal agencies involved in child
and adolescent research programs came together to examine the federal investment in this area and to foster coordinated efforts. The
major goals of the Subcommittee were to:
(A list of representatives and a chronology of their discussions is included in Appendix A.)
- Assess the size and scope of the Federal research portfolio on children and adolescents, and identify gaps in the current knowledge base and in the research funding.
- Identify key research issues in children's biological, cognitive, and social development.
- Strengthen research-policy linkages and develop a sustainable
process for collaboration and communication of scientific knowledge about childhood and adolescence within the Federal Government.
The Current Federal Investment
One question the Children's Initiative sought to answer was "How much does the Federal Government spend on research and development related to children and adolescents?" To
identify this Federal research and development portfolio (R&D), RAND's Critical Technologies
Institute (CTI) conducted an analysis using a newly developed database (RaDiUS) of research
and development activities across the Federal Government (see
"About the Data Analysis" box). This analysis was refined by additional
input from Federal agencies. These R&D efforts address a broad range of issues affecting children's biological, cognitive, emotional, and social
development, as well as the factors shaping their behavior from the prenatal period until their entry into the labor force.
|ABOUT THE DATA ANALYSIS|
RAND's Critical Technologies Institute (CTI) conducted its analysis using the RaDiUS
database that contains information submitted annually OMB by all Federal agencies about
their R&D projects. The database currently contains approximately 80 percent of all Federal
domestic R&D projects related to children and adolescents. The remaining 20 percent
was determined by the assumption that the proportion of each agency's R&D remained the
same as represented in the 80 percent. A number of agencies also provided information
directly to CTI to supplement the RaDiUS data. "Children's research" encompasses the life
cycle period from prenatal to entry into the labor force and includes research directly related
to the physical, cognitive, psychological, and social development of children and youth.
Care must be taken, however, in the interpretation of the data. Some agencies may report program evaluation studies to OMB as part of their
R&D, while others may not. For this reason, the agency-specific CTI
figures cited in this report must be interpreted with caution.
CTI identified R&D projects for children and adolescents by reading
agency project abstracts. For each project identified as focusing on children and adolescents, CTI characterized the research.
Appendix B contains a more detailed description of CTI's methodology
and a list of the Federal departments and agencies included in the
The CTI analysis aimed to estimate the Federal portfolio; it is not a comprehensive, in-depth
examination of each Federal R&D project related to child and adolescent development.
CTI found that, in fiscal year (FY) 1995, the Federal Government spent an estimated $2
billion on R&D directly related to children and youth. These funds were distributed among 12
Federal departments including eight agencies within the U.S. Department of Health and Human
Services (HHS) and 21 funding components within the National Institutes of Health (NIH) and
three independent Federal agencies. The National Institute of Child Health and Human
Development (NICHD), the National Institute of Mental Health (NIMH), and the Department of
Education (ED) account for about half of the research. However, each of the 15 Federal
departments and independent agencies has a specific mission for its R&D efforts, which is often
linked closely to its service programs, and provides valuable findings to enhance the knowledge
base about children and adolescents. A key challenge lies in collecting, analyzing, and
synthesizing what this knowledge base tells us about what the Nation can do to ensure the healthy development of all American youth.
There are several ways to put in perspective the estimated $2 billion Federal R&D investment in
children and youth. One way is to compare this investment to the total Federal R&D budget,
which includes research on defense, energy, health and other topics. Such a comparsion shows
that Federal R&D on children represents less than three percent of the total Federal research
investment of $71 billion, and about six percent of the $33 billion non-defense R&D budget (Chart 1).
It is equally important to place children's R&D in the context of the Nation's total R&D expenditure--including all levels of government and the private and nonprofit sector. The private and nonprofit sectors provide more total R&D funding than the Feder
al Government--an estimated $100 billion in FY95. However, little of this private and nonprofit research is directed toward research on children (excluding product-oriented marketing research). Foundations spent an estimated $75 million on research for
children in FY95, and the remaining nonprofit sector and State and local governments probably contributed less than $300 million. Thus, the share of total national R&D directed toward children is less than 1.2 percent.
Unlike other areas of research, the Federal Government bears almost total responsibility for R&D on children. For instance, the private sector provides over 50 percent of health and energy R&D funding and over 90 percent of transportation R&D. In contra
st, the Federal Government provides approximately 90 percent of children's R&D. Thus, it is even more essential that the Federal research portfolio be well coordinated across agencies and adequate to address the critical social, educational and health is
sues facing children.
A second way to consider the investment in R&D for children is as a proportion of total expenditures on children. The U.S. investment in R&D is between 2 and 3 percent of national expenditures (Gross Domestic Product, or GDP). In the areas of health, en
ergy and transportation, the Nation invests between 2 and 3 percent of expenditures in R&D. This R&D commitment of 2 to 3 percent is directed toward making the expenditures in each area more
effective and efficient.
In contrast to the 2 to 3 percent commitment in other areas, less than three-tenths of a percent of the expenditures on children is spent for R&D on children. Total government expenditures for children and youth in FY1995 were an estimated $555 billion,
almost two-thirds of which was
devoted to K-16 education. Most of the remaining funds were allocated for social welfare (including AFDC, Medicaid, Head Start, WIC, and Food Stamps), criminal justice (including police, courts, and prison expenditures), health care, and other programmat
ic expenses (Chart 2). Private sector expenditures for children are far larger than public sector expenditures, so our
total R&D commitment to children of $2 billion to $2.4 billion is certainly less than three-tenths of a percent of public and private expenditures for children.
Given these comparisons, an obvious question is whether the Nation's investment related to child and adolescent R&D is consistent with our research investments to solve other social, economic, energy, transportation and health problems. Put another way,
the estimated $2 billion
investment is aimed at understanding the growth and development of 30
percent of the Nation's population--over 80 million children and adolescents under age 21. The lack of dramatic progress on some youth-related problems may stem from having limited R&D funding that must be spread across the spectrum of developmental prob
lems arising during the first 20
years of life.
This research investment in children must address not only all developmental issues (social, emotional, cognitive and health) from before birth to age 21, but also a wide range of social issues (such as education, social services, and delinquency). In a
ddition, this research seeks not only to address the developmental issues and problems which arise during childhood, but also to
uncover the origins of health conditions that are manifested later in life but have their genesis and best hope prevention in childhood. The annual health care cost of four such conditions alone (atherosclerosis, osteoporosis, diabetes, and obesity) exce
eds $100 billion.
Younger Americans may benefit from programs for which they are not specifically a target group. The funding for these programs, such as those directed toward general health and family research, is not included in the estimate of the amount directed expli
citly at child research.
Although a great deal of knowledge about young people has been
gained from past research in the social, behavioral, and life sciences,
a clear need exists to further advance our understanding of what enables
all children to grow up to be healthy and active members of society. To
develop effective policies and programs regarding children, adolescents,
and families, an integrated, multidisciplinary approach is essential.
The Children's Initiative Subcommittee identified the following
cross-cutting, interrelated themes as among those that should
characterize such an approach.
- Recognize the importance of basic, theory-informed,
hypothesis-driven research on developmental processes.
Fundamental research on developmental processes during the prenatal
period, infancy, childhood, adolescence, and young adulthood
should be a cornerstone of the child and adolescent research
enterprise. Such knowledge provides an essential foundation from which
to design programs, inform public policy, and conduct research on
efforts to promote child and adolescent health. This research yields
information that can help address not only problems that occur in
childhood, but also those that do not appear until later in life but have
their antecedents in childhood. Such health conditions
include atherosclerosis, diabetes, osteoporosis, obesity, and some
- Understand a child's overall development over the long
term. Research should address the relationships among
biological, cognitive, social, and emotional aspects of human
development over the life course. Though research is making strides in
this regard (for instance, there are links between social and cognitive
development research), insufficient efforts have been made to link
cognitive, social, and emotional domains to biological factors. The
multiplicative effects of risk factors are rarely considered. Our
understanding of how the whole child develops during the first two
decades of life, therefore, remains limited.
- Examine child and adolescent development in the context of
their families and communities. A multidisciplinary research
approach should create, improve, and sustain longitudinal studies of
representative samples of all children over at least the first two
decades of life and preferably into adulthood. (Minority and poor
children have been the primary focus of problem-oriented research. They
are too often neglected in normative developmental research, which
typically focuses on children from white, middle-class families.) Such
a long-term strategy will help to increase our understanding of how
families, peers, schools, community organizations, media, and other
social institutions together influence the totality of child and
adolescent development. Recognition of multiple influences is critical
to the design of programs and formation of public policy.
- Attend to "positive" outcomes for children and
adolescents. Mission-oriented research, by definition, focuses
on problems and deficits. For example, research efforts -- as well as
policies and programs -- are often centered on health-threatening or
compromising behaviors; comparatively few efforts examine
health-enhancing behaviors. However, many children and adolescents do
adopt positive behaviors and more attention is needed to find ways to
help teens, families, schools, communities, and the media encourage such
behaviors. Health promotion approaches are inextricably linked to
knowledge about how key environmental and situational influences
facilitate or hinder young people's efforts to ensure their health
and well-being. Policies oriented toward helping more young people
succeed will require knowledge about how health-enhancing behaviors can
be achieved in diverse populations.
Illustrative Research Issues
This section of the report provides starting points for how the Federal
Government can focus its research efforts to address high-priority
issues affecting the health, safety, education, and
development of all American children and youth. As a first step in
identifying research opportunities, a selected literature review was
conducted of reports that summarized relevant
research and recommended areas for future study (see Appendix C for
selected bibliography). To broaden the perspective, each Federal agency
represented on the Children's Initiative Subcommittee was asked to
submit its top research priorities for the coming years.
During discussions to identify illustrative research issues, the
Children's Initiative Subcommittee considered the following criteria:
the nature and importance of an issue's impact on children,
youth, families, and larger society; the degree of public concern about
the issue; the extent to which the scientific community is prepared to
advance knowledge of this issue; and the potential for improved research
understandings to effectively inform policy (i.e., does a "policy
window" of opportunity exist?).
Working from the above cross-cutting themes and principles, the
Children's Initiative Subcommittee identified six research opportunity
areas concerning the development of children
and adolescents that merit further exploration in the next phase. These
six areas are: (1) influence of families and communities on child and
adolescent development, (2) health and behavior, (3) children and
environmental hazards, (4) understanding learning, (5) policy research,
and (6) longitudinal studies. An overview of each area follows,
outlining current knowledge in this area, topics that need to be
explored further, anticipated benefits of advancing the knowledge base,
and suggestions for which Federal agencies could work together to act on
these research opportunities. Taken together, the six research areas
create a functional path that enables us to look at all facets --
biological, cognitive, social, and emotional -- of children's development.
These six research opportunity areas should be considered illustrative
starting points for thinking about the Federal research
investment strategy. They are not meant to be the final word on the
Federal research agenda, nor do they represent an exhaustive list of all
research questions that will inform policies and programs regarding
young people's development. For example, two of
the six issue areas -- policy research and longitudinal studies -- cut
across the other four areas.
Research leading to reliable, useful indicators of child and family
well-being is a key element of any research enterprise; however, this
initiative did not address this element because it concluded that there
was sufficient current activity in this area by the Federal Interagency
Forum on Child and Family Statistics, Partnerships for Stronger
Families, and the NICHD Child and Family Well-Being Research Network.
Improved communication among these and other related public- and
private-sector research efforts should be established to further enhance
the knowledge base about children and adolescents.
1. HEALTH AND BEHAVIOR
What We Know. The coming century will witness the
expansion of research in behavioral medicine. Children and adolescents
will be a special focus of biobehavioral research and of initiatives
based on such research that informs efforts to promote health and safety
and prevent injury and disease. This focus on young people is
imperative because disabilities and chronic diseases resulting in adult
morbidity and mortality can be traced directly to behavioral patterns
that are often established during childhood and adolescence.
Research has established that a number of personal behaviors are major
determinants of long- and short-term health outcomes in children and
youth. For instance, the initiation of unhealthy or risky behavior such
as substance abuse (including tobacco use), drinking and driving, early
or unprotected sexual intercourse, poor nutritional choices, lack of
exercise, violence, not wearing safety belts, and not using bicycle and
motorcycle helmets is related to poor outcomes during early adolescence
and beyond. Given this knowledge, the Federal Government collects
information to indicate the general health and well-being of children and
youth. The Youth Risk Behavior Survey, for example, monitors serious
health-risk behaviors (e.g., unintentional and intentional injury,
tobacco, alcohol and other drug use, sexual behaviors, dietary
behaviors, physical activity) that contribute to the leading causes of
mortality, morbidity, and social problems among young people.
|RAISING THE AGE FOR DRINKING|
Motor vehicle crashes are the leading cause of death for those ages five
to 24. Research conducted under the auspices of the NHTSA has
influenced policy decisions regarding drinking and driving.
In the early 1980s, legal drinking ages for adolescents varied (from 18
years to 21 years) among the States. Research showed that raising the
legal drinking age to 21 had a direct effect on reducing alcohol-related
traffic crashes among 18- to 20-year old drivers. As a result of these
findings, and in response to growing concern over the disproportionate
involvement of young drivers in alcohol-related traffic crashes,
Congress enacted the National Minimum Drinking Age Act in 1984,
requiring all States to raise the minimum age of purchase and public
possession of alcohol to age 21, or face loss of highway construction
By 1988, all 50 States and the District of Columbia had enacted laws
making it illegal for anyone under the age of 21 to purchase or possess
alcoholic beverages. Subsequent research documented that State laws
setting the legal drinking age at 21 have reduced traffic fatalities
involving drivers 18 to 20 years old by 13 percent and have saved over
15,600 lives since 1985.
Research also has provided evidence on the effectiveness of particular
prevention strategies designed to modify or prevent certain health-risk
behaviors. Environmental interventions such as child safety seat, seat
belt and motorcycle helmet laws, requirements for child-resistant
packaging for certain chemicals and pharmaceuticals, and restrictions on
the availability of harmful substances to minors have proven successful
in reducing risk. Education interventions, particularly those that
involve life skills training, can also lead to reduced risk; for
example, studies have shown an association between school-based health
education and the reduction of tobacco use in children. While
information-based interventions are important, they are insufficient to
sustain changes in behavior. Interventions that involve multiple
sources of influence within a child's physical, social, and
psychological environment (via family, school, church, peers, and other
social institutions) are more likely to be effective than approaches
that stem from a single institution. Furthermore, cultural and gender
factors may influence the effectiveness of particular prevention
What We Need to Know. Major strides have been made during
the past few decades in understanding how health problems of children
and youth develop, but the following gaps in our knowledge, while not an
exhaustive list, remain:
- What influences children and adolescents to avoid or engage in
risky and adverse behaviors? To increase the likelihood of
healthy youth and adult development we must better understand what
prevents young adolescents from engaging in adverse behaviors in the
first place. If they do adopt risk-taking behaviors, what influences
them to do so and how can such actions be effectively modified? This
requires a more advanced understanding of (1) the factors that influence
negative risk behaviors -- for example, the incentives within a child's
or adolescent's environment that serve to sustain these behaviors; and
(2) the factors that influence positive, healthy behaviors and the
conditions in which such factors thrive. Knowledge about how to
strengthen and maintain the impact of positive forces in young people's
lives is essential to development of policies and programs that
facilitate health-enhancing behaviors.
- What is the nature of the health behavioral change process for
children and youth? Research is needed not only to capture what
contributes to health-compromising and health-promoting behaviors, but
also to understand the process of behavioral change in children and
adolescents. Existing models of health that are related to behavioral
change have focused mainly on adults. Very little is known about
behavioral change for young people, for whom the process may be even
more complex given the wide variation in child and adolescent
- To what extent does maternal nutrition influence whether a
child will develop chronic diseases later in life? The
influence of maternal nutrition on fetal brain development, hormones,
and blood supply has enormous public health implications. However,
little is known about the effects of a specific micronutrient
deficiency-macronutrient imbalance or overconsumption of calories during
pregnancy on the development of chronic diseases in later life.
- What are the cumulative effects of adverse and risky behaviors
on child and adolescent development? Research is needed that
looks beyond specific problems of injury, violence, delinquency, teen
pregnancy, substance abuse, and other risky behaviors in isolation to
consider how these problems intersect and connect. For instance,
knowing whether common behavioral mechanisms are contributing causes of
multiple health risks would provide the basis for developing more
effective intervention strategies. There is a need for research on the
social, cultural, and behavioral factors influencing "risky behaviors"
which result in trauma injuries to children and youth. Transportation-
related examples include (1) drinking and driving, (2) failure to wear
bicycle or motorcycle helmets, and (3) improper use of, or failure to
use, child restraint systems or seat belts.
- How do health risk behaviors compare among different age
groups? The majority of research conducted and data collected
on youth and health-risk behaviors focuses on older adolescents. Our
capacity to monitor younger children's health and well-being is
currently limited -- especially in the areas of social and behavioral
development. Information is very much needed on such development for
different age groups, especially middle childhood. Such research will
help to inform the timing of intervention strategies. Although it may
be more difficult, the optimal time to study children in relation to
health-risk behavior is during the transition from middle childhood to
the teen years. To teach children about the potential effects of current
behavior and help them develop the necessary skills to avoid engaging in
risky behavior requires more extensive knowledge about social
relationships that children form during middle childhood and the
influence that peers and the media can have on experimentation and
acquisition of adverse or positive health behaviors. The contribution
of gender, ethnicity, and socioeconomic status to understanding
age-related development should also be considered.
- How do environmental, family, and situational influences
affect child and adolescent health-risk behaviors? Research
shows that how parents interact with their children can affect the
extent to which young people are initiated into risky behaviors.
Research is needed to identify the most effective strategies families
can use to support their children's healthy development. This is
particularly true during middle childhood, when parents can play a
critical protective role in guiding children's acquisition of healthy
behaviors. Research is also needed on the effects of other
environmental and situational influences -- such as the media and
popular culture, peer groups, schools, and community organizations -- on
the health-risk perceptions and behaviors of children and adolescents.
All of these influences are potential tools in designing effective
health promotion approaches.
- How do children and adolescents perceive the risks of engaging
in health-compromising behavior and what approaches would help them to
adopt more health-enhancing behavior? Though most youth who
engage in health-compromising behavior understand the long-term
consequences of their actions, they may not consider such repercussions
relevant and, therefore, are unlikely to change their behavior.
Research which takes into account different socioeconomic backgrounds
and different ethnic or racial groups should address questions related
to children's understanding of potential
risks and outcomes. Such research should also explore their
developmental capacities to perceive relationships between their actions
and the short- and long-term consequences. For example, children who
smoke do not consider the long-term consequence of cancer to be as
relevant as the short-term consequences of peer acceptance, and the
effect of smoking on breath and teeth. For some, immediate social
acceptance may be a more powerful influence than poor health, especially
if it occurs during their adult years.
How Federal Agencies Conducting Research Could Work Together in
this Area. The NIH Office of Behavioral and Social Sciences
Research is playing a major coordinating role across the NIH to assure
that the behavioral aspects of health are well integrated into the
Nation's health research enterprise. The National Science Foundation
(NSF) supports disciplinary research on the cognitive and
decision-making underpinnings of risk perception and behavior. At the
same time, other agencies of the Federal Government such as the CDC, ED,
USDA and the U.S. Department of Transportation (DOT) are engaged in
efforts to promote health and prevent disease and injury. The U.S.
Department of Justice (DOJ) supports programs and approaches to prevent
and treat violence, now considered a major threat to public health.
Research findings have now established that problematic outcomes in
child and adolescent health do not occur in isolation from one another.
Health-compromising behaviors, such as poor diet, smoking, and
inadequate exercise and fitness, tend to cluster in the same
individual. Likewise, health-enhancing behaviors, such as regular use
of seat belts, and avoidance of harmful substances such as tobacco, also
tend to cluster. This line of evidence indicates that child and
adolescent health and behavior initiatives in the future must involve
agencies, that, heretofore, have focused on specific health outcomes.
2. CHILDREN AND ENVIRONMENTAL HAZARDS
What We Know. Children face a wide array of major
environmental health threats, including lead poisoning, chemicals and
pharmaceuticals, pesticides, air and water pollutants, drinking water
contaminants, toxic waste dumps, second-hand tobacco smoke, and
polychlorinated biphenyls (PCBs). The effects of these environmental
hazards can be debilitating. Children exposed to such threats can
experience a host of problems, including asthma, cancer, central nervous
system damage, respiratory illnesses, behavioral and learning problems,
and delayed development. Asthma deaths are on the rise in children and
young people, increasing by 118 percent between 1980 and 1993, and
asthma is now the leading cause of children's hospital admissions. Lead
poisoning is also a leading environmental health hazard for young
children, affecting as many as 900,000 children ages five and under,
according to the CDC.
|REDUCING CHILDHOOD LEAD POISONING: SIGNS OF PROGRESS14|
Efforts to understand the extent of lead poisoning in America's children
began to flourish in the 1950s, as people became more aware of the
harmful effects of lead exposure and its
sources. Lead poisoning adversely affects three major organ systems in
the human body: the central nervous system (specifically, the brain),
the kidneys, and the blood-forming
organs. Children can experience lead exposure not only from lead-based
house paint, but also from leaded gasoline, drinking water, and
Numerous Federal agencies - the EPA, the NIH, the CDC, ASTDR, HUD, and
the CPSC - have cooperated to generate the data needed to understand the
consequences of lead exposure to infants and children as well as how to
prevent and treat it. One of the greatest
steps in protecting children's health occurred 20 years ago, when the
EPA phased out lead in gasoline and the CPSC also banned lead in
residential paint, coatings, and certain other consumer products.
In the 1980s, studies tracking children from birth showed that levels of
lead in children's blood previously thought to be safe were, in fact,
associated with serious neurological and behavioral problems such as
impaired coordination, increased aggressiveness and
hyperactivity, and lower IQ scores. CDC revised their screening
guidelines for acceptable blood lead levels in children, from 60 g/dL in
the 1960s to 10 g/dL today. In 1991, CDC recommended that virtually all
children be screened for lead exposure and poisoning.
CDC, HUD, EPA and CPSC issued strategies for elimination of lead
poisoning. Together, these efforts have led to a 98 percent reduction
in lead levels in the air and protected millions of children against
serious, permanent learning disabilities. From 1976 to 1993, the
percentage of children ages one to five with blood lead levels higher
than acceptable levels decreased from 88 to about 4 percent.
Though lead levels in children have significantly declined, this
environmental health hazard currently affects as many as 0.9 million
children age five and under. The fact remains that lead exposure is an
entirely preventable childhood health problem. There is still much to
be done to protect children -- particularly those living in lower income
areas or in older homes threatened by chipping or peeling paint and
excessive amounts of lead-contaminated dust. What is more, there is a
host of other environmental hazards, the effects of which on child and
adolescent development are still not fully understood; even less is
known about their cumulative effects and the risks they pose to
Research shows that children are at special risk, compared to adults,
from these and other environmental hazards in three general ways.
First, because children's bodies and organs are still developing, they
are often more susceptible to environmental threats. Children move through
several stages of rapid growth and development, from conception and
infancy through adolescence, during which they can be particularly
sensitive to exposure to environmental toxins. Second, because children
eat proportionately more food, drink more fluids, breathe more air, and
play outside more than adults, they are exposed to more environmental
threats. Children thus may ingest more pollutants per pound of body
weight. Finally, because children are least able to protect themselves,
their behavior exposes them to additional environmental hazards.
Children's natural curiosity and tendency to explore leave them
vulnerable to health risks adults can more easily avoid. When young
children crawl on the ground or the floor or play outside, they are more
exposed to a wide array of potentially hazardous substances.
The Federal Government (including the Environmental Protection Agency
(EPA), the National Institute of Environmental Health Sciences (NIEHS),
the CDC, the Consumer Product Safety Commission (CPSC), the Agency for
Toxic Substances and Disease Registry (ATSDR), and the Department of
Housing and Urban Development (HUD)) has made important contributions to
answering some of the questions concerning the effects of environmental
hazards on children. These activities range from basic research to
systematic evaluations examining whether environmental protection
efforts are adequately safeguarding children's health. The EPA has
recently proposed new pesticide and chemical testing guidelines to more
completely identify neurological, developmental, and reproductive
effects on children.
What We Need to Know. Through research on the risks
associated with exposure to environmental hazards, significant gains
concerning the health and well-being of children and adolescents have
been made. Yet much more can be done to protect children from
environmental health hazards. Questions that require further
- How can we improve the identification of and response to
environmental threats to children's health? Although progress
has been made toward quantifying the risk environmental hazards pose to
children, our ability to identify environmental threats to children's
health and then develop effective strategies to address them must improve.
While a great deal is known about some hazards, researchers are just
beginning to understand others more fully. For example, increasing
scientific attention has been focused on the potential effects of
synthetic chemicals on the hormone system. These chemicals -- known as
endocrine disruptors -- may pose a major hazard to children. A number
of chemicals, including organochloride pesticides such as DDT and chemicals
such as PCBs, can cause endocrine disruption in wildlife and laboratory
animals. Because very low levels of chemicals that block or mimic
reproductive and thyroid hormones can determine the course of prenatal
development, there is substantial concern about the potential for birth
defects and alterations of normal growth and development in
children from suspected endocrine disruptors. The NSTC Committee on
Environmental and Natural Resources (CENR) has established a committee
to coordinate endocrine disruptor-related research throughout the
- How can we prevent cumulative exposures to a hazardous
substance from multiple sources? Even if risks from a chemical
are known, it is difficult to reduce these risks when the exposures
occur from unrelated sources, particularly when the chemical accumulates
in the body. The most effective approach is for agencies to address the
problem in a coordinated and comprehensive program. As an example, lead
from leaded gasoline, paint, industrial processes, soil, food, water,
dust, certain consumer products such as miniblinds, and toys are sources
of lead exposure to children. Individually, some of these exposures are
adverse; others are not. However, since lead and lead damage is
cumulative in the body, the sum of exposures adds to the body burden and
increases the risk of toxic effects. Agencies took a holistic advisory
and regulatory approach to prevent hazardous lead exposures from
multiple sources. The Federal Lead Paint Task Force, consisting of some
20 different Federal regulatory and advisory agencies, and public and
private groups, informed and organized childhood lead poisoning
prevention activities. Partnering of public and private efforts, such
as the National Lead Information Center (800-424-LEAD), can bring
expertise and resources together to address specific lead exposure
concerns from a variety of sources. The total success is reflected in
the reduction of the average blood lead level for young children in the
United States to 3.6 ug/dl from a late 1970s high of 15.0 ug/dl.
- What are the cumulative effects of hazardous
substances? Even when there is sound information about specific
hazardous substances, very little is known about their cumulative or
synergistic effects. Traditionally, most environmental protection
regulations examine risks on a chemical-by-chemical basis, although in
reality people are exposed to multiple substances at the same time. For
example, the National Academy of Sciences (NAS) report, Pesticides in
the Diets of Infants and Children, identified this single-chemical
approach to regulation as a major shortcoming in the Federal pesticide
and food safety regulatory system, particularly as it relates to
children. Responding to concerns expressed in the report, pesticide and
food safety laws were recently amended, mandating that EPA assess
?aggregate exposure? to pesticide residues, including all sources of
exposure to chemicals with a common mechanism of action, when
determining safe levels of pesticides on food.
- What kinds of hazards are those to which children are most
sensitive, and why? While it is clear that children are more
vulnerable to environmental hazards in general, more detailed
information is needed. For example, while children are often more
susceptible to environmental threats because their immune, neurological,
and other systems are still developing, it is not known to which hazards
children are more sensitive, or why.
Also, children face physical hazard susceptibility regarding motor
vehicle-related injuries because they have smaller bodies, and because
adults may direct where they sit and may decide whether safety devices
are used. Motor vehicle-related injuries are the major cause of death
for those ages five to 27.
- When are children most vulnerable to environmental
hazards? Further research is needed to identify windows of
particular vulnerability to environmental hazards. Children move
through several stages of rapid growth and development throughout
infancy and adolescence, during which they may be especially sensitive
to the effects of exposure to toxic substances. Research is needed to
help identify these windows of heightened susceptibility in order to
focus environmental protection efforts on the highest risk exposures and
on outcomes with the greatest potential effects on normal intellectual
and physical development.
How Federal Agencies Could Work Together in this Area.
Effective partnerships are required to achieve a healthy environment for
children. Federal agencies charged with protecting public health and
the environment must work together to achieve desired outcomes for young
people. One such collaborative effort might be the development of
public health guidelines on environmental issues to improve children's
health. The ATSDR provides a written series for this purpose. The EPA
develops testing and risk assessment policies for environmental
A potential opportunity for collaboration within HHS is a recently
established Subcommittee on children and environment. The subcommittee,
convened by the HHS's Environmental Health Policy Committee, is charged
with coordinating the activities of relevant HHS agencies conducting
work in this area. Other agencies such as EPA, the Department of Energy
(DOE), and CPSC have been invited to be liaisons to this activity.
Another potential coordinating point is EPA's Children's Environmental
Health Initiative. One EPA proposal is to fund academic institutions to
advance the understanding of how children are exposed to environmental
hazards and children's susceptibilities and vulnerabilities to
environmental hazards. The EPA has committed to establish two national
Centers of Excellence on Children and Environmental Health in academic
institutions. Such an endeavor could be undertaken as a partnership by
several Federal agencies. For example, the USDA provides data to the
EPA to help monitor and establish estimates of exposure to pesticide
residues in foods. The agencies are currently working together to
obtain additional data specific to infants and children.
An existing hub for research coordination is the NSTC CENR. The
Subcommittee on Risk Assessment has provided a powerful stimulus to
standardizing and coordinating the approaches of all Federal agencies to
health and environmental risk assessment, and assessment-related
research. The CENR Subcommittee on Toxic Substances coordinates
research on these topics.
The ATSDR Child Health Initiative, launched in 1996, has focused the
agency's programs and public health actions on reducing the adverse
effects of toxic substances on the health of infants, children, and
youth. This initiative is intended to (1) place a special emphasis on
child health issues, (2) implement new projects that benefit children
and their families, and (3) solicit input and disseminate information
through other government agencies, professional organizations and child
3. UNDERSTANDING LEARNING: STUDIES ON COGNITION,
What We Know. Understanding learning is one of the great
challenges in studying the brain and behavior. Children are capable of
learning a remarkable variety of tasks relatively rapidly, and continue
learning throughout life. Recently there has been widespread
recognition that individuals process information in different ways and
have preferential methods of learning: visual or auditory stimulation,
hands-on learning, repetition, or other pathways. Our Nation's
investment in education depends upon being able to incorporate an
understanding of learning into supporting activities and practices to
increase the human capacity to learn. Effective approaches must also
include understandings of the requirements of different minority
populations, including learning disabled children, and effective
techniques based on the interplay among educational, social, and
behavioral contexts. Basic research is needed on how children learn, on
neurologic pathways and brain adaptability, on environments that
stimulate learning and remote memory, and on techniques, including the
application of information and communication technologies, that can
support and encourage learning at higher levels.
DEVELOPMENT, AND LEARNING TECHNOLOGIES
Currently, the NSF, the ED, and the NIH all support research related to
cognitive development and learning. Enhanced research investments that
build upon the convergence of concepts, models, and technologies used in
many related disciplines have the potential to yield significant
benefits for learning research. Disciplines that contribute to the
study of learning in natural and artificial systems, and to the
techniques and methodologies for supporting enhanced learning include
the social and behavioral sciences, mathematics and the physical
sciences, and education and cognitive sciences. An interagency research
focus could build on all of the strengths of different participating
agencies, capitalizing on ongoing research efforts, fostering cooperation,
and highlighting interdisciplinary approaches that offer the highest
potential to serve our Nation's education and human resource needs.
What We Need to Know. Science has already demonstrated
that the importance of learning and creativity in the first two decades
of life cannot be underestimated, yet our knowledge base is limited.
Many questions still remain.
The examples cited here are not meant to be exhaustive. They represent
research needs that could be more capably addressed through
interdisciplinary approaches. The unique contributions and research
strengths of each agency are important to address these issues.
- Studies on learning disability. The following themes
will support ongoing and enhanced research on how to bypass physical or
mental impairments which can limit learning.
- Basic research on brain function, neural networks, and learning
models to improve understanding of the causes and implications of
certain learning disorders.
- Basic research on brain adaptability and compensation to overcome
- Research on technologies that facilitate learning and help children
to overcome problems associated with learning impairment.
- Research on mental or environmental stresses that result in impaired
- Research on basic processes or environments that facilitate and
enhance natural learning processes, including the creation of effective
learning tools that support and guide individual learning for people of
all ages in various settings.
- Testing and evaluating different learning models and approaches in
|GAINING ACCESS TO LEARNING THROUGH TECHNOLOGY|
For more than 40 years, the Office of Special Education Programs (OSEP)
in the ED has supported special education research intended to provide
practical answers to questions about how best to educate children with
physical, sensory, cognitive, and emotional disabilities.
OSEP supports research that looks at how children can learn using
technology. These validated technological tools and practices can help
children with disabilities become independent and successful learners in
their schools and at home. Previously, many of these children would
have been denied access to education and become dependent on their
families or the government for their care and support. As a result of
this independence, the annual cost savings to the public is over $10
Today, more than four million children with disabilities are attending
neighborhood schools with their non-disabled classmates.
Research-validated technology can be a powerful factor in helping them
develop the knowledge, skills, and self-confidence they need to lead
personally fulfilling and successful lives. For example, the Kurzweil
machine, which converts written words into Braille and speech, helps
more than 175,000 blind persons who are presently enrolled in school or
employed in our country's workforce. Moreover, this optical character
recognition technology enables personal computers to directly receive,
edit, and send facsimile messages. Millions of Americans are using
advanced telecommunications technology that was developed in part with
OSEP discretionary support.
- Learning at Higher Levels. Research approaches have
the potential to yield important results with respect to an individual's
ability to learn in meaningful ways. Interdisciplinary research to
enhance children's ability to think critically, process, and communicate
information will depend upon research gains on the following topics.
- Understanding of selective attention and memory management in learning systems.
- Development and testing of information management tools based on combined
insights from neuroscience and cognitive science with methods employed by
mathematical scientists, engineers, biologists, biochemists, and psychologists.
- Research on basic cognitive development and successful techniques to promote higher learning.
- Research on mental representations and memories including how they are
constructed, selected at a given moment, and accessed to solve novel problems.
- Development and application of technological tools to enable higher learning and enhanced memory capability.
Many other problems and issues associated with supporting and maximizing learning potential similarly require interdisciplinary approaches and understanding. Research on basic cognition, approaches to learning, and limits and enhancements to learning abi
lity will be generalized to other educational and workplace challenges individuals face into adulthood.
- What effect do multimedia technologies have on children's development? Computers and technology are fast becoming a part of everyday life for children and adolescents, both in and out of school. Yet little is known about how powerful,
multimedia technologies and the images they produce affect the information processing, knowledge and decision-making skills of children. Understanding of the effects of the mass media and electronic marketing (e.g. Internet) on health-compromising choice
s such as inadequate diet and exercise, smoking, alcohol and drug use remains limited, yet is potentially critical to efforts to improve health practices.
- What is the role of nutrition in enhancing a child's ability to learn? Research findings suggest that nutrients play an important role in the brain functioning and cognitive development of children and adults. Additional research is nee
ded to define the role of key nutrients in neurological function to understand how diet affects development during gestation and early developmental stages, and what nutrients are required for optimal cognitive development and peak functioning. Understand
ing what nutrients result in improved cognitive functioning throughout life would have important bearing on policy development regarding nutritional requirements during early development and beyond.
- What are the effects of childhood head injury on learning and intelligence? Head injury is a leading cause of accidental death and disability among children. Studies have shown that children under the age of 14 years are more likely to
sustain head injuries than adults, and that children's head injuries are often of increased severity. Despite the high incidence of head injury among children, studies addressing mechanisms of injury, recovery from injury, and impact on learning and int
elligence are lacking. Development of head injury models that allow meaningful predictions of severity of head injuries related to a wide variety of sports and recreation-related children's activities is needed. Also, models are needed that can differen
tiate abuse-related injuries from head injuries due to falls.
How Federal Agencies Could Work Together in this Area. Different agencies of the Children's Initiative have unique capabilities and strengths with respect to research on learning. Working together, the potential for advances in theory and
application is heightened. Transferability of data and methods to classrooms and other learning sites will also be improved.
The NSF has unique capabilities with respect to interdisciplinary research in this area since it supports basic research on all of the science and engineering fields involved in the study of learning. In 1996, NSF initiated an activity, Learning and Inte
lligent Systems (LIS), that will fund high-risk, multidisciplinary basic research and technology development on the learning processes in humans, and in artificial systems. Though LIS does not focus specifically on children, the initiative contributes di
rectly to the understanding of learning and cognitive development generally, including the development of prototype technologies to support and enhance higher-level learning. The research methods employed will also have broad applicability to other resea
rch on children. NSF has focused this activity on integrating technology with research and on exploring unifying concepts in the many disciplines that contribute to the study of learning and intelligent systems. LIS's research focus recognizes that advan
ced information and communication technologies are radically transforming the way people will live, learn, create, and work in the 21st century, and responds to the need to provide supportive technologies that enhance the human ability to learn and create
. In addition to the LIS program, NSF also supports basic research in social and behavioral sciences, biology, and other related fields. Through enhanced support, large-scale testing and implementation projects could be initiated; research initiatives c
ould be accelerated.
The NIH also has unique capabilities for funding and conducting research on all aspects of the health sciences, including neurosciences and environmental health effects. Basic research on brain function, pathways, and brain disorders is ongoing at NIH la
bs and through research grants. With respect to research on learning disabilities, NICHD-sponsored research on dyslexia has recently resulted in new techniques for diagnosing and treating the disorder. Other interdisciplinary, large-scale, and collabora
tive research projects would be more feasible with enhanced support and cooperation with other agencies.
The ED funds research targeted specifically at education and learning, including process evaluation and models, methods and technologies for learning. Direct involvement of the ED in basic and applied research on learning promises rapid advances in both
theory and application. Working together with other agencies of the Children's Initiative which focus on more basic research understanding, the ED has much to offer and gain from interdisciplinary and collaborative efforts.
The Department of Defense (DoD), with both its research and educational programs, could be an important partner in such an effort, given its work in information technology as well as human capital development. The DoD also is expert in the applicability
of advanced simulation and presentation techniques, such as virtual reality, to other instructional settings. This work could be applied in the transportation sector for example, the applicability of simulator technology to driver education.
4. INFLUENCE OF FAMILIES AND COMMUNITIES ON
What We Know. Families and communities make a difference at every stage in a child's development, beginning even before a child's birth and continuing into adolescence. Research is significantly advancing our understanding of the complex w
ays in which families and communities provide children with opportunities for healthy development or expose them to risks for serious problems. (The term ?community? should be broadly interpreted, encompassing various public and mediating institutions su
ch as schools, community groups, religious institutions, the media and popular culture.)
CHILD AND ADOLESCENT DEVELOPMENT
Research involving infants, for example, is identifying how their interactions with responsive caregivers (parents and other adults) provide the foundations for developing a healthy sense of self, forming trusting relationships, and taking pleasure in lea
rning and exploring the world.
Research also is documenting the importance of children's direct interactions in middle childhood and adolescence with their parents as well as with mentors and peers. Findings are shedding new light on important variations in parents? and other adults?
abilities to structure and influence children's access to and use of resources -- human and institutional -- in their communities. Such adult mediation of the community influences children's involvement in positive experiences or in high risk behaviors s
uch as substance abuse and violence.
There also is new evidence of the importance of building networks of relationships that provide an expanding circle of support for both child and family. Research results on early intervention strategies to promote responsive caregiving and healthy infan
t development underscore the
importance of focusing on both child and family development (i.e., a two-generational strategy), and attending to the role of community conditions and resources. Studies involving families with
similar signs of stress indicate that lower child maltreatment rates are associated with the presence of community supports (e.g., churches, Boys and Girls Clubs, school-based community programs). In addition, findings show that parenting practices known
to be effective in communities in which there are many resources and few problems are not as effective in
communities in which conditions undermine parents' goals, expectations, and interactions with their children. As demographic changes bring about greater cultural diversity, studies are beginning to map both the similarities and the differences among cult
ural groups in the ways that family and community influence children's lives.
This growing knowledge base is beginning to stimulate a broad range of policy approaches that emphasize working with families and communities to provide children and adolescents with the social networks and supports they require to make a successful trans
ition into adult life. For instance, research has played a vital role in the design and implementation of the new Early Head Start program. Based on principles drawn from research on service delivery, Early Head Start enables communities to design flexi
ble and responsive programs to provide comprehensive child and family support services to low-income families with children under the age of three. Longitudinal research is built into the program to generate knowledge that can be used both to improve ser
vices and to assess impacts on children, their families, and their communities.
Further, projects supported by the National Institute on Drug Abuse (NIDA) are applying knowledge about childhood predictors of drug use to the development and refinement of preventive interventions that focus on involving schools, families, and peers. I
n another example, the Centers for Disease Control and Prevention (CDC) is developing Human Immunodeficiency Virus (HIV) interventions involving at-risk adolescents and their parents based on research that shows that strengthening familial communication i
ncreases the likelihood that adolescents will adopt HIV risk-reduction behaviors. Also, CDC is documenting the positive role of comprehensive school-based health education in influencing the health-risk behavior of adolescents.
What We Need to Know. Given the challenges facing our families and communities, it is essential to build on our current knowledge base and focus on how changes in families and communities can be harnessed for the benefit of children, taking
into account gender and racial/ethnic variations. Here are several pressing questions for which answers are needed:
- How do families and children (or youth) access community resources? There is limited knowledge about how community-based support structures are established and how families and children (or youth) access available resources. In addit
ion, scientific information is limited about how contemporary media and popular culture influence children and youth and what that means for how families, community groups, and others
should interact with youth to convey important information about their health, education, and well-being. Little is known, for example, about when, where, under what conditions, and at what ages various communication strategies are effective with differe
nt child and adolescent groups. Likewise, further information is needed about how the availability of
transportation transforms the perception of the resources that are "accessible," and those which are not.
- How do different components of the community contribute to the development of self-protective safety behaviors in children and adolescents? Understanding the roles played by parents, caregivers, preschool and school teachers, coaches, o
lder siblings, peers, and others in the development of safe behaviors could lead to strategies to foster development
of such behaviors early in life. Longitudinal behavioral studies that assess relevant characteristics and influences of these groups of people on the development of safe behaviors in children are essential to the development of sound policies and program
- How can communities facilitate an adolescent's safe passage to adulthood? This transition cannot be understood without linking adolescence to development that occurs during early and middle childhood. Thus, longitudinal research that ca
ptures individual development over time and also assesses the characteristics and influences of families and communities is essential to advance our knowledge and better inform policy and practice.
- How are families and communities changing and how does such change positively and adversely affect children and adolescents? The scientific literature strongly suggests that instability in the lives of children and adolescents can adver
sely affect their development and well-being. Research indicates that frequent changes in residence, childcare arrangements, or the adult composition of the household can prevent children and adolescents from establishing stable relationships with adults
and peers. Children undergoing such changes may also lack supervision in their homes and communities. Observed results should be explored for their utility in policy interventions. It is also critical that we understand the dynamics of positive change
s in communities and neighborhoods.
- How are children, families, and communities affected by major policy innovations now taking place at national, State, and local levels (e.g., in health care delivery, family income support, and economic self-sufficiency)? For example, p
rovision of income
support by the States (rather than by the Federal Government) may result in powerful
policy incentives that induce impoverished families to change their residence and
household structure frequently. These changes could occur because of the availability of State funding, time-limited benefit structures, and different programs that might arise out of welfare experimentation at the State and local levels. Such residenti
al mobility will challenge research on welfare reform experiments at the local level. It will require tracking changes in residence and how those changes affect children. Longitudinal designs that are robust enough to account for these changes over time
and a diversity of State and local policies are needed to evaluate adequately the effects of welfare experiments at the State and local levels and to support States in developing welfare policies that enhance child and adolescent development while preven
ting serious problems.
- How do policy choices regarding physical infrastructure and urban and rural economic development affect children? While about 70 percent of this country's poor live in central urban or rural areas (U.S. Bureau of the Census, March Curr
ent Population Survey, 1995) most job growth is occurring in the outer suburbs, resulting in a spatial
mismatch between jobs and poor people. Research should include efforts to analyze: (1) the importance of transportation and mobility for children's and families? overall well-being, and (2) how lack of access to residential transportation may hinder c
hildren's and families' social, educational, and emotional development.
How Federal Agencies Could Work Together in this Area. Researchers and those involved in esigning preventive programs share an interest in family and community support for children and adolescents. These support systems are often referred
to as ?contexts? for development to be understood in their own right and for engaging families and communities in facilitating positive outcomes in young people. Thus, a broad range of Federal research agencies is now supporting projects in this area. T
he ED for instance, is providing support through (1) its research institutes that aim to connect families and communities in supporting the optimal educational achievement of children, and (2) its reorganized elementary and secondary education programs wh
ich confer a greater decision-making role at the school level in exchange for accountability for higher student achievement. Other agencies involved include HHS through its research and prevention programs, including comprehensive community-based health
promotion programs in substance abuse, mental health, and cardiovascular health; and the CDC through its efforts to promote health and prevent violence and diseases.
Collaborations among these research agencies, especially those that strongly connect educational and health outcomes in children and adolescents, are needed. Young people who are healthy are more likely to benefit from educational opportunities. Likewis
e, research shows that children
and youth who are doing well in school and have supportive families are more likely to engage in health-enhancing behaviors (and less likely to engage in those risky to their health) than are those who are doing poorly in school.
5. LONGITUDINAL STUDIES
What We Know. Longitudinal studies that collect information on the same group of participants over time have proven to be important research tools for understanding how children develop and what factors influence their ability to become hea
lthy and productive adults. The principal
advantage of longitudinal designs is that they enable researchers to measure developmental processes and the factors influencing these processes as they occur.Just as the well-known Framingham longitudinal study of adults has taught us much about the role
s of health, nutrition, and behavioral factors in cardiovascular disease, longitudinal studies concerning children have provided much knowledge about such factors as the impact of early
experience (including healthy diets and exercise programs) on child development, the benefits of fluoridation of water on dental disease, the neurological effects of low-level lead exposure, and the long-term effects of birth trauma. Current longitudinal
studies, such as the National
Longitudinal Survey of Youth, the Study of Early Child Care, the National Education Longitudinal Study, the National Longitudinal Study of Adolescent Health, and NSF's longitudinal study, the "Panel Study on Income Dynamics (PSID)", are contributing impor
tant information to the knowledge base on children and adolescents. Though these studies are difficult to implement and sustain, they yield valuable information that can be achieved in
virtually no other way.
What We Need to Know. Longitudinal studies provide a mechanism for understanding what factors are most important in influencing a child's life course. Such knowledge is essential in ensuring that all children grow up to be healthy and cont
ributing adults, thereby reducing
significant medical and social costs associated with adverse outcomes. Here are several longitudinal studies that could help us achieve this knowledge:
- How does children's development in normal conditions compare to what occurs in adverse conditions? A major gap exists between our understanding of how children develop in normal conditions and what happens to children who are at risk be
cause of abuse and neglect, homelessness, institutionalization, violence, criminal activity, and
other adverse conditions. It is important to conduct studies that bridge this gap to increase our knowledge of why some children manage to overcome these disadvantages and go on to lead productive lives.
- How can families and social institutions help children acquire
the values, motivation, knowledge and skills to become socially responsible and productive adults? Recent advances in the biomedical, social, and behavioral sciences now enable the design of longitudinal studies that can inform how to optimize ch
ildren's potential as they make the
transition to adulthood. This requires a better understanding of how children prepare themselves for the working world, manage their activities, perceive and manage risks, and develop time-use skills in ways that facilitate their productive capabilities.
A longitudinal study integrating multiple scientific disciplines would allow biological, psychological,
social, and anthropological perspectives of child development to be blended with an economic framework of human capital investments in children by families and society. Research has progressed and such studies are feasible. Further, we, as a nation, hav
e come to realize how much our future depends on developing our children's potential to its fullest.
- How do various childhood experiences affect later adult behavior? Great Britain has pioneered a special type of longitudinal approach called a birth cohort study, in which a large, population-based sample of newborn children is identifi
ed and followed for several
decades into adulthood. This type of study has been very successful in connecting biomedical, behavioral, and social information to develop a comprehensive portrait of how childhood experiences help shape later adult behavior and outcomes. Recent scient
ific advances also suggest birth cohort studies may be an effective approach for understanding why children's developmental processes may differ across ethnic and socioeconomic groups -- an area in which there are currently few answers. Birth cohort
studies also hold promise for assessing the neurocognitive effects of psychotropic agents (e.g., Prozac, Valium) on fetal and postnatal brain development and other structures and functions, as well as the impact of nutrition and environmental toxins and e
xposures, during and after pregnancy. Longitudinal studies may help us to better understand the factors in childhood that contribute to safe or unsafe driving behavior, particularly
drinking and driving, and use or failure to use seat belts and child restraint systems. Such studies could also determine impact of childhood injuries (e.g. head injuries) later in life. Many nations around the world have or are planning to launch simil
ar studies. If the United States conducted a comparable study, a cross-national database for understanding
child and adolescent development under different and similar social and economic conditions would be possible.
- What kinds of childhood and adolescent interventions are most effective in preventing adverse health behaviors? Many diseases or health-threatening conditions affecting adults have their origins during the perinatal period and in childh
ood. Preventive measures can be most effective if interventions take place during these formative years.
Longitudinal studies are needed to study interventions on representative populations over time to test their effectiveness, which may not become apparent until years later. A Children's Health Study could address some of the highly significant, long-term
health issues in children that can be resolved only in longitudinal studies. Such a study would be analogous to the Women's Health Initiative, which was initiated because no long-term
studies on a representative group of women had been done to assess adequately the effects of hormone replacement therapy on osteoporosis, breast cancer, and heart disease; or the effect of reducing dietary fat on breast and intestinal cancer. The lifetim
e benefits of knowledge gained from such studies in children would be significant.
A Children's Health Study involving several different cohorts could explore in greater depth the effectiveness of a number of major preventive intervention issues including: strategies to increase children's calcium intake and prevent osteoporosis, dieta
ry and exercise measures to reduce the risk of adult cardiovascular disease, therapeutic and other
interventions to prevent obesity (one of the most prevalent adverse health conditions in children today), effective injury prevention programs (including motor vehicle injuries), individual and community-based interventions to prevent teen smoking, identi
intervention programs for children with mental health disorders, and newly developed education interventions to help children with learning disabilities.
An emerging area is research on preventive interventions in areas including accidents and injury, substance abuse, adolescent pregnancy, youth violence, and obesity. Studies demonstrate that reducing substance abuse by young people requires more than pro
viding information about the dangers of drugs. Information must be supported by teaching young people skills to resist peer influence and providing timely booster sessions throughout the high school years to sustain those initial sessions. Comprehensive
community-based health promotion strategies that involve parents, local organizations,
and the media indicate that multi-level interventions can be effective in preventing substance abuse, but must be sustained over time.
A Children's Health Study, as an analogue of the current Women's Health Initiative, is one of the best ways to provide answers in the coming decades to many of the most pressing problems facing children today and in the future. Such a study would serve a
s a highly visible sign of our Nation's commitment to its children. If the research portfolio on young people does not include longitudinal studies, the timing and content of health
promotion and disease prevention efforts will not be as well informed by fundamental research on child and adolescent development as they must be.
How Federal Agencies Could Work Together in This Area. Longitudinal studies would greatly benefit from multiple agency involvement. Studies of vulnerable children are of interest to the Departments of Health and Human Services, Justice, Ed
ucation, Commerce, the CPSC and the
National Highway Traffic Safety Administration (NHTSA). Knowledge gained from birth cohort studies would be relevant to NIH, FDA, CDC, CPSC, USDA, and other agencies. Studies of learning disabilities could build on current interagency cooperation betwee
n NIH and ED, which provides a useful model for these types of studies. The NSF-sponsored Panel Study on Income Dynamics (PSID) contains data on the impact of economic variables and conditions on
child development and attainment.
6. POLICY RESEARCH
What We Know. Policy research is a less developed field than some other areas of children's research, especially those focusing on the basic science of development. Nevertheless, there have been important accomplishments in this area. One
example is the research on the benefits
of early education programs. Longitudinal studies over the past three decades indicate that high-quality early childhood education programs, coupled with parent education, can have long-term benefits for children such as lower school drop-out rates, and
reductions in adolescent pregnancy,
involvement in the juvenile justice system, and referrals to special education programs. These studies have contributed to the position that investing in early childhood education is cost-effective in preventing later, more costly treatment and intervent
ion programs. (See box, "Early
Childhood Programs: They Can Make a Difference" and "Overcoming Adversity: It Can be Done," in the Overview.)
What We Need to Know. This is a critical time for researchers to assess how children and adolescents are affected by policy and regulatory changes. Major restructuring of longstanding social policies has the potential to affect large numbe
rs of children and their families. Several reports have identified, with the participation of the research and policy communities, critical areas for policy research in income support, health care delivery, food assistance, educational attainment, and th
e transition from school to work. Here are just a few cross-cutting examples of issues researchers are grappling with that have important policy implications:
- What are the effects of State-level variations in health care, welfare reform, and other services? For both health care and welfare reform, there is a need to ensure that State-level variations in implementation and outcomes are closely
monitored and measured. In health care, changes in the financing system may affect not only access to health care, but also the nature and kind of care children and adolescents receive. Though welfare reform legislation provides States with greater fle
xibility to redesign income assistance for families and children, it also establishes time limits and requirements for work participation that aim to change parents? responsibilities for supporting their families.
- What are the combined effects of policy changes on child well-being and what
implications do they have on effective service delivery? Families will be affected by a combination of policies that respond separately to basic needs for food, health care, housing, safe neighborhoods, quality child care and schools, and a relia
ble source of income. Policymaking must be informed by assessments of the combined effects of these changes on child well-being. State governments and other groups are seeking better ways to respond to the needs of children and their families and are try
ing out a variety of ways to integrate services through comprehensive State and community initiatives, systemic reform efforts, and other broad-based strategies. Because standard experimental methods are not always suited to studying changes of this scop
e, the advancement of a broader array of research methods also needs to be a focus of policy research.
- How will investments made to meet societal infrastructure and mobility needs affect the development and attitudes of children in areas where these investments are made? Large-scale investments in physical or information infrastructure s
ystems create basic, long-term changes in the perceived and actual well-being of the people living in or near the area where they are made. These impacts must be taken into account during the decision-making process that leads up to them. The following
issues are particularly important to study:
- How Federal investments in transportation systems and other kinds of physical infrastructure can improve children's chances of growing up healthy and productive, particularly in central urban and rural areas with limited access;
- How national transportation and infrastructure policies can support Federal welfare reform, health care improvement, and other major national quality-of-life goals; and,
- How Federal policies dealing with economic growth, transportation, and
infrastructure investment influence State, local, and private-sector decisions and priorities regarding land use, education and health care, and community development.
- What prevention and intervention models will best foster the
health and well-being of children and adolescents? Research is needed not only to identify when prevention and intervention approaches to prevent problem outcomes should take place, but also to determine how effective such approaches are in redu
cing problem outcomes. In addition, little scientific knowledge exists on what kinds of prevention and intervention strategies work best and the extent to which approaches must be tailored for different groups of children and youth to be effective. Yet
another important area of research that needs to be explored regarding prevention and intervention is the cost-effectiveness of different strategies.
- What data sources will enable us to monitor and assess how changes in key areas of health and safety, human services, education, and other sectors affect children and adolescents? A potential strategy for organizing Federal research in
this area would be to focus on identifying and, as needed, creating the data resources to achieve at least the following: (1) establish national and State baselines for child and adolescent well-being on a core set of measures to provide data that enable
the tracking of trends in child health and safety, education, and well-being; (2) establish State baselines for service provision by documenting, for example, how services are organized and delivered, and their effects on low-income children; and (3) desi
gn and conduct child impact studies that have the methodological rigor to establish cause and effect relationships between policy and program changes and the health, safety, and well-being of children and adolescents.
One possible starting point would be to enhance the National Health Interview Survey (NHIS) to be fielded by the National Center for Health Statistics (NCHS) of the CDC next year. These surveys yield national estimates of health status derived from both
physical examinations and survey questions, medical expenditures and family formation, and they can be extended to some large States. An improved statistical system on children, youth, and families could be formed by building on the NHIS nucleus.
How Federal Agencies Could Work Together in This Area. Because effective approaches involve the delivery of services in many areas and yield multiple benefits for children and their families, Federal agencies and other groups should find it
advantageous to partner in conducting new policy research on promising approaches. Where as the testing of new strategies requires funds not only to conduct research but to also develop and provide services, partnerships are likely a feasible route for
overcoming the limitations of a given agency's area of authority or budgetary resources.
A multi-agency partnership effort could involve the HHS's health, social services and welfare research, the ED's research programs, the National Institute of Justice's juvenile justice research initiatives, HUD's research programs, USDA's research on food
assistance programs, and education and training efforts undertaken by the Department of Labor.
Those who shape our Nation's policies and programs related to children,
youth, and families are searching for answers to questions about how our
Nation can ensure that all of America's children will grow up to be
healthy, productive citizens. Many of these questions seek to address
the immediate, highly visible threats facing our children and youth
(such as underachievement, disease, substance abuse, and injury). Still
others focus on identifying and preventing the long-term consequences
that may arise 10, 20 or even 30 years after the onset of certain child
and adolescent behaviors. For instance, children who smoke, do not
exercise, or fail to eat a nutritionally balanced diet today may not
exhibit serious health, developmental, or other problems until later in
their adult lives -- when it can be extremely costly or even too late to
Basic research is a first step -- a fundamental underpinning -- toward
answering these and other questions and closing gaps in our knowledge
about child and adolescent development. Indeed, theory-driven, applied
and policy-related research efforts that address and build on the six
opportunity areas identified in Section II are prime starting points.
Advanced knowledge of family and community influences on children's
behavior, for example, would help to determine what role families and
communities can best play in shaping healthy lifestyle decisions
regarding substance abuse, smoking, violence, nutrition, pregnancy and
sexuality, and other risky behaviors. Exploring neurological and
cognitive development at different ages with varying degrees and kinds
of stimulation would also provide information about what kinds of
learning situations facilitate optimal growth and development of the
skills young people need to lead productive adult lives.
Knowledge gained in these and other areas can and should inform and
facilitate action to address our Nation's urgent and costly social and
economic issues. But for Federal research to be more effectively used
in policy and program development, researchers must improve the ways in
which they communicate and disseminate important findings to
decision-makers. The scientific research community must work to
establish new links and strengthen existing ones with policymakers and
service providers. Likewise, policymakers and service providers, for
their part, must not only assist researchers into identifying key
research questions concerning children, youth, and families, but also
must take responsibility for acting on relevant research findings. When
successful, such connections can have powerful and beneficial results on
children's well-being (see boxes in this section and additional examples
provided in Appendix D).
|RESEARCH-POLICY LINKAGES: LESSONS FROM |
COMPUTING AND INFORMATION SCIENCE AND TECHNOLOGY
The field of computing and information science and technology may
represent the most effective linkages among the research, policy, and
service sectors. University researchers interact frequently with
industry researchers, both through scientific societies and by actually
moving between these sectors. Similarly, policymakers at the Federal
and other levels are likely to have worked in one or both areas. The
ease of movement of people in this field facilitates knowledge transfer
and fosters understanding among the sectors. Industry recognizes its
dependence on the research base and frequently funds work in
universities and in the private sector. These effective interactions
among sectors were described in the 1995 NAS report, Evolving the High
Performance Computing and Communications Initiative to Support the
|SUDDEN INFANT DEATH SYNDROME|
Sudden Infant Death Syndrome (SIDS) is the leading cause of death among infants from one month to one year of age. Though the causes of SIDS remain unknown, research efforts have facilitated scientific breakthroughs and enabled the development of public
health strategies to combat it.
Research sponsored by the NIH over the last two decades has identified risk factors associated with SIDS, the effects of sleep position on infant health, and other related issues. This information led the American Academy of Pediatrics to recommend, in 1
992, that babies be placed on their backs or sides to sleep. In addition, research conducted by the CPSC provided the first epidemiologic evidence that infants who sleep on their stomachs on top of soft bedding (e.g., pillows, comforters) are likely to r
ebreathe carbon dioxide. The research showed that rebreathing carbon dioxide trapped in bedding may have contributed to the deaths of as many as 30 percent of the infants initially diagnosed as experiencing SIDS. CPSC warned the public about the hazards
of soft bedding through Safety Alerts, a national press conference, and by joining in the "Back to Sleep" public health campaign. The "Back to Sleep" campaign was launched in 1994 and sponsored by a coalition of Federal agencies, the American Academy of
Pediatrics, the SIDS Alliance, and the Association of SIDS Program Professionals.
These events have been credited with lowering the percentage of babies placed on their stomachs to sleep from over 70 percent to less than 30 percent, and helping to reduce the death rate from SIDS by 30 percent in the two-year period from October 1993 to
October 1995. This is a prime example of how research can be linked to practice and program development to achieve a national objective.
Thinking About Linkages
Given the complex issues affecting child and adolescent development, improved connections between researchers and those who develop policies, programs, and regulations concerning the future of young people must be an essential part of the Federal research
strategy. It is a responsibility that falls to all of those involved -- researchers, policymakers, program administrators and regulators, and direct service providers. Yet, more extensive communication among these groups is not enough. Too often, rese
arch is conducted, then policies and programs are implemented based on the initial findings, and the chain of events stops there -- with little or no follow-up on the effects and effectiveness of actions taken.
Rather than viewing research linkages with policies and services as sequential in nature, these connections should be thought of in terms of a continuing feedback system, with multiple entry points for feedback and modification in the decision-maki
ng process at the Federal, State, and local levels. Such a strategy would enable researchers not only to inform initial policy and program development, but also to monitor and evaluate the implementation of these policies and programs -- and their effect
s on child, adolescent, and family status -- on an ongoing basis. Sustained research could provide knowledge that is essential in further shaping and refining policies and programs so that they more effectively address the problems facing our children an
In thinking about how to create and sustain this continual feedback system, the broader landscape in which researchers, policymakers and service providers work must be considered. The very nature of this landscape suggests that a set of conditions must b
e in place if successful linkages are to occur, and entry points and feedback opportunities are to be provided. Here are three examples of such conditions that illustrate the complexity of research-policy linkages; these are by no means exhaustive.
- Top Leadership. Fundamental to any successful linkage among researchers, policymakers, and those in direct contact with children and adolescents is the commitment of high-level Administration officials. Strong leadership is necessary t
o creation of a climate in which scientific knowledge is perceived to be important and actually is used as an important factor in decision-making about policies and programs that affect the future of children, youth, and families. Within the Executive Br
anch, coordination between the NSTC and the DPC on the scientific basis for policy initiatives concerning children and families must be strengthened through the creation of specific linkage mechanisms.
- Stronger Linkages with University Researchers and Professional Organizations. Universities and professional organizations are major sources of relevant research knowledge concerning child and adolescent development. As such, they must
actively expand their efforts to build and strengthen links to those who develop policies and programs affecting children, youth, and families. In addition, universities have a special responsibility (and opportunity) to prepare future generations of res
earchers so they can effectively connect research to policy and program development.
- Clear Lines of Communication with State and Local Policymakers and Service
Providers. Lack of communication about, and dissemination of, knowledge are not
problems limited to Federal agencies, university-based researchers, and professional
organizations. It happens among others as well, most notably with those at the State and
local levels who find themselves faced with new policy and program responsibilities, and a need for reliable knowledge to make informed decisions and effectively carry out these responsibilities. Not only are States, communities, non-governmental organiz
ations, and others involved in service delivery important users of information, but they are also becoming important sources of critical data concerning child and family well-being in an era of devolution of human services. Establishing close linkages be
tween universities and their surrounding neighborhoods and cities can be a way in which knowledge creation and utilization can be connected for mutual benefit, and for improving opportunities for children.
At the national level -- in child and adolescent development and other fields -- several approaches have been used to bridge the realms of policymakers and researchers to effect knowledge transfer or utilization. For example, the NAS and its various boar
ds were created to advise the Federal Government in shaping research agendas and identifying policy options regarding a broad range of issues. The White House initiated Partnerships for Stronger Families to make the Federal Government a more responsive a
nd supportive partner in efforts to implement comprehensive community-based initiatives to serve children and families. And, more recently, the NSTC called for the establishment of a multi-agency task force to examine the long-standing university-governm
ent partnership aimed at advancing science and technology in the national interest.
In its effort, the Children's Initiative tackled the question of linkages from a specific perspective -- how the Federal research investment on child and adolescent development can be more effectively used to inform our Nation's domestic policy. The Chil
dren's Initiative thus sought to
answer these fundamental questions: How can we create and strengthen the linkage between two key agencies within the Executive Office of the President ? the NSTC (which coordinates the diverse parts of the Federal R&D enterprise) and the DPC (which overs
ees the development and
implementation of the President's domestic policy agenda)- in a way that fosters important research and policies? And how can this linkage create effective collaboration among and with other Federal agencies that support research on children and adolesce
nts? Recommendations for how to establish and sustain such strong relationships are addressed in the next section.
Though the Children's Initiative was asked to focus solely on research-policy linkages at the Federal level, the group strongly urges similar linkages at the State and local levels.
A Need for Collaboration
In its discussions about establishing and strengthening research-policy linkages, the Children's Initiative identified an essential steppingstone to success: increased multi-agency collaboration and coordination of research on national priorities related
to children's health, education, and well-being. Just as linkages should cut across public and private sectors and span all governmental levels, the Federal Government's collaborative approach should also strive to tap the knowledge and experiences of n
on-governmental researchers. Strategic partnerships with interested public and private sources will be instrumental to addressing the current and emerging needs for relevant data and knowledge concerning children and adolescents.
Calls for more coordination and collaboration in research have been a consistent theme of public and private sector assessments of the research enterprise regarding children and youth. At this juncture, however, there are two compelling reasons why colla
boration is even more critical than in the past.
First, the current fiscal climate requires more strategic use of existing Federal research dollars. As noted in Section I, the Federal Government currently bears primary responsibility for supporting research on children and adolescents. Yet Federal age
ncies are working in an environment driven by constrained resources and public opinion that the Federal Government must scale back. Collaboration and strategic partnerships with other public and private sources are thus needed to leverage resources and m
aximize their impact on research portfolios concerning children, youth, and families.
|FEDERAL INTERAGENCY FORUM ON CHILD AND FAMILY STATISTICS|
The Forum is a multi-agency effort established in 1995 to improve and coordinate the federal information base about children and families. It has established committees to coordinate the reporting of federal statistics on children and families, improve t
he collection of such data at the federal level, and coordinate federal data collection and reporting efforts with State and local government efforts. At regular Forum meetings a wide variety of Government agencies, NGOs, and University researchers parti
cipate to discuss these issues.
Important factors in the success of the Forum are that it is a bottoms-up effort driven by senior staff of participating agencies and representatives of NGOs and university scholars, and that it cuts across agencies and disciplines to help develop a compl
ete and comprehensive picture of family life and child well-being. Statistical, research, and policy agencies are involved in discussions and it has established partnerships among federal
agencies and with university-based scholars, charitable foundations, and private non-profit organizations. It also includes representatives from policy making entities within the Federal Government, policy-oriented researchers in the university community
, and policy-oriented non-profits.
Accomplishments of the Forum include success in gathering of statistics about child and family well-being, compiling Government statistics into a preliminary list of the most critical indicators of child and family well-being; and in collaboration with Pa
rtnerships for Stronger Families produced a comprehensive list of these indicators. It has also co-sponsored and coordinated a series of conferences to improve the knowledge base on
fathers' involvement with their families and children.
Second, research on the separate facets of children's development is moving toward a multidisciplinary approach -- an integration of biological, cognitive, social, and emotional development and the role social institutions play in children's overall devel
opment. No one agency, on its own, can effectively address the complexity and broad spectrum of issues and fully
explain the dynamics of their interaction.
The boxes in this section on Partnerships for Stronger Families, the Federal Interagency Forum on Child and Family Statistics, and Research-Policy Linkages in Computing and Information Science and Technology provide insights and lessons for developing pro
mising models of multi-agency collaboration and research-policy linkages.
|PARTNERSHIPS FOR STRONGER FAMILIES|
Partnerships for Stronger Families is an interagency effort that seeks to make the Federal Government a more responsive and supportive partner in community initiatives to improve outcomes for children and families. A steering committee representing the W
hite House offices and six Cabinet-level departments meets monthly to guide the work of cross-agency action teams. Specific topics are explored and recommendations are developed. The current areas of focus include: Technical Assistance, National Indica
tors, Financing Flexibility, Information Dissemination, and Promoting Intergovernmental Partnerships.
The keys to success for the Partnerships include: (1) cross-agency control and ownership,(2) high-level convening and support and sustained commitment from the top, (3) shared principles and vision, (4) credible convener(s) who do not push a top-down app
roach,(5) active private sector involvement, including the Annie E. Casey Foundation, and participation of State and local practitioners, policymakers, and program administrators from various disciplines, and (6) establishment of concrete, short-term, ac
The Partnership for Stronger Families makes recommendations for short-term change that inform broader policy efforts. These efforts are coordinated by the DPC, National Performance Review, the Community Empowerment Board, and OMB.
A report regarding a system of national indicators of child and family well-being is in draft form. Recommendations for restructuring Federal technical assistance to comprehensive community initiatives are being reviewed.
It is time to embark on a multi-agency research effort to address critical issues concerning America's youth. This section outlines a vision and strategy for how the Federal Government can strengthen its research enterprise on children and adolescents, a
nd connect that enterprise more closely with domestic policymaking. The problems facing today's children, adolescents, and families continue to intensify. The Federal Government remains the primary (and virtually only) source of support for scientific r
esearch directed toward securing their health, education, and well-being and, thus, our Nation's future. This longstanding role will continue amidst changed conditions. Further, the reality of constrained budgets necessitates that research must play a m
ore central role in increasing our capacity to have more informed policy and program development than in the past.
One thing is clear: No one Federal agency can foster the scientific advances required to strengthen our Nation's investments in its children and youth. Coordination and strategic partnerships among Federal agencies are needed to leverage resources and m
aximize their impact on the healthy development of the Nation's youth. What is more, the Federal Government alone cannot achieve these results; collaboration with other public and private organizations is essential.
To meet this challenge, the Children's Initiative Subcommittee recommends that an Interagency Working Group (IWG), such as the Task Force established in the Executive Order Protection of Children from Environmental Health Risks and Safety Risks, identify
activities within their research portfolios that support, inform, and facilitate the achievement of the Administration's
key goals of ensuring the optimal health, education, and well-being of all American children and youth.
The IWG will address priorities for multi-agency research activities concerning children, adolescents, and their families. Among the prime candidates for such activities emerging from the first phase are a children's health initiative to understand how c
hronic health problems, which emerge in later life, can be better prevented; an effort to develop public health guidelines regarding environmental (including standards and regulations) interventions to reduce risks to safety and health among children; and
a learning and technology initiative to understand how children learn in interaction with new, evolving technologies and how such technologies can be better designed to promote learning in schools and other settings.
The IWG's responsibilities should include, but not be limited to, the following:
- Develop and implement a long-term strategic planning process - to advance a multi-agency Federal R&D effort related
to the optimal development of children and adolescents. The six
research opportunities presented in Section II can be used as starting
points for this planning process. This process should include the identification and recommendation of appropriate partnerships among
public (i.e., Federal, State, and local) and private sector parties
(e.g., industry, private philanthropy) interested in ensuring the
healthy and productive development of children and adolescents.
The results of the strategic planning process should be presented to
- Identify key research investment opportunities regarding
children and adolescents - to achieve the overarching goals outlined
in the strategic plan. These investment opportunities should highlight
the need for and the benefits of a multi-agency, coordinated approach in
scientific research concerning young people. OSTP and OMB would play an integral role in working with the IWG to develop a coordinated strategy, including budgetary issues, in which agencies can collaborate on research problems of national concern. Thes
e problems include strengthening the collection of reliable child and adolescent indicators and the research that provides us with the factors that influence these indicators over time. A coordinated research strategy on optimal human development from ea
rly childhood into young adulthood, particularly on factors supporting learning and development knowledge, should be a high priority.
- Identify mechanism(s) to strengthen research-policy linkages - not only among NSTC, DPC, Federal agencies and State and local government, but also among relevant non-governmental organizations and other public and private sector parties
at the national, regional, and community levels. Such extensive linkages are needed to ensure that research knowledge generated by Federal agencies and other researchers is effectively used to inform policy and program development regarding children, you
th, and families. The means for strengthening such linkages should occur on a regular, sustained, and timely basis.
- Consider appropriate means for conducting an outside assessment of the IWG's work - to ensure that the Federal Government's strategic plan and identification of key research investment opportunities, potential strategic partnerships, and
mechanisms for strengthening research-policy linkages regarding children and adolescents are on target. The IWG could, for instance, convene an Advisory Board of public and private sector experts from diverse disciplines or engage a relevant governmenta
l or non-governmental entity to undertake this assessment.
A Final Note
Our Nation has a clear stake in ensuring that all of America's children grow up to be healthy, educated, productive, and contributing adults. Scientific research is and will continue to be a catalyst for achieving that goal; it serves as a fundamental in
strument for informing, developing, implementing, and refining policies and programs that address the pressing needs of children and adolescents. As such, research must be at the forefront of the highest level of decision-making. The Federal Government
is faced with an opportunity to embark on a path that will lead to creating and sustaining conditions that optimize human development and citizenship. Now is the time to take that first step - to establish a coordinated multi-agency research approach tha
t emphasizes partnerships among the public and private sectors and linkages between the research and policymaking communities.
1 President Clinton's State of the Union
Address to Congress, January 23, 1996.
2 Sources: Births and Deaths for 1995,
(1996). U.S. Department of Health and Human Services, Centers for
Disease Control and Prevention, National Center for Health Statistics,
Washington, D.C.; Monthly Vital Statistics Report (June 24,
1996), U.S. Department of Health and Human Services, Centers for Disease
Control and Prevention, National Center for Health Statistics, 44(11),
Washington, D.C.; Trends in the Well-Being of America's Children and
Youth: 1996 (1996). U.S. Department of Health and Human Services,
Office of the Assistant Secretary for Planning and Evaluation,
3 Sources: Reading Literacy in the United
States (1996). U.S. Department of Education, Office of Educational
Research and Improvement, Washington, D.C.; Third International
Mathematics and Science Study (1996), U.S. Department of Education,
National Center for Education Statistics, Washington, D.C.; Great
Transitions: Preparing Adolescents for a New Century (1995),
Carnegie Council on Adolescent Development, Carnegie Corporation of New
York, New York, NY.
4 Sources: Births and Deaths for 1995
(1996). U.S. Department of Health and Human Services, Centers for
Disease Control and Prevention, National Center for Health Statistics,
Washington, D.C.; Trends in the Well-Being of America's Children and
Youth: 1996 (1996). U.S. Department of Health and Human Services,
Office of the Assistant Secretary for Planning and Evaluation,
Washington, D.C.; Starting Points: Meeting the Needs of Our Youngest
Children (1994), Carnegie Corporation of New York, New York, NY.
5 Sources: "National, State, and Urban Area
Vaccination Coverage Levels Among Children Aged 19-35 Months - U.S. June
1994-July 95," Morbidity and Mortality Weekly Report, Centers for
Disease Control and Prevention, Washington, D.C.; Overcoming Barriers
to Immunization (1994), Institute of Medicine, National Academy Press.
6 Sources: Butterfield, F. (1995), All God's
Children: The Bosket Family and the American Tradition of Violence,
Knopf Publishers; "Prison Spending Hurts Schools and Black Students, Report
Says," Los Angeles Times, October 23, 1996.
7 Sources: Baugher, E. and Lamison-White, L.
(September 1996). Poverty in the United States: 1995, Current
Population Reports, U.S. Department of Commerce, Economics and Statistics
Administration, Bureau of the Census, U.S. Government Printing Office,
Washington, D.C.; Trends in the Well-Being of America's Children and
Youth: 1996 (1996). U.S. Department of Health and Human Services,
Office of the Assistant Secretary for Planning and Evaluation,
8 Source: Great Transitions: Preparing
Adolescents for A New Century (1995). The Carnegie Council on
Adolescent Development, Carnegie Corporation of New York, New York, NY.
9 Sources: Trends in the Well-Being of
America's Children and Youth: 1996 (1996), U.S. Department of Health
and Human Services, Office of the Assistant Secretary for Planning and
Evaluation, Washington, D.C.; "Projected Smoking-Related Deaths Among
Youth - United States," (November 8, 1996), Morbidity and Mortality
Weekly Report, 45(44), Centers for Disease Control and Prevention,
Washington, D.C.; "Vital Statistics Mortality Data, Multiple Cause of
Death Detail, 1993." (1993). National Center for Health Statistics,
public-use data tapes available from the National Technical Information
Service, Springfield, VA. NTIS Accession No. PB-96-501861.
10 Sources: "Long-Term Outcomes of Early Childhood
Programs," (1995) The Future of Children, 5(3); Years of Promise: A
Comprehensive Learning Strategy for America's Children, (1996),
Carnegie Corporation of New York, New York, NY.
11 Sources: Dallman, P. (1990) in Brown, M. (ed),
Present Knowledge of Nutrition (6th edition), International Life
Sciences Institute, Washington, D.C.; Gerrior, S. and Zizza, C. (1994),
Nutrient Content of the U.S. Food Supply, 1909-1990, Home
Economics Research Report on Nutrition and Mentoring, No. 52, U.S.
Department of Agriculture, Washington, D.C.; Guthrie, J. and Schwenk, N.
(1996), "Current Issues Related to Iron Status: Implications for
Nutrition Education and Policy," Family Economics and Nutrition
Review, to be published in Fall issue; Herbert, V. (1992), "Everyone
Should be Tested for Iron Disorders," Journal of the American
Dietetic Association, 12;
Ludwig, W. (1996), Statement before the Subcommittee on Agriculture,
Rural Development and Related Agencies of the Senate Committee on
Appropriations, U.S. Senate, Washington, D.C.; Oski, F. (1993), "Iron
Deficiency in Infancy and Childhood," New England Journal of
Medicine, 329(3); Quick, J. and Murphy, E. (1982), The Fortification
of Foods: A Review, Agriculture Handbook No. 598, U.S. Department of
Agriculture; Randall, B. and Boast, L. (1992), Study of WIC
Participant and Program Characteristics, Prepared by Abt Associates,
Inc., Cambridge, MA for the U.S. Department of Agriculture, Food and
Nutrition Service; Stuart-Macadam, P. and Kent, S. (eds) (1992),
Diet, Demography, and Disease: Changing Perspectives on Anemia,
Aldine De Gruyter, Hawthorne, NY; Third Report on Nutrition Monitoring
in the United States: Volume I (1995), Federation of American Societies
for Experimental Biology, Life Sciences Research Office; Yetley, E. and
Ginsman, W. (1983), "Regulatory Issues Regarding Iron Bioavailability,"
Food Technology; Yip, R. et al. (1987), "Declining Prevalence of
Anemia Among Low-Income Children in the United States," Journal of
the American Medical Association, 258(12).
12 President's FY98 Budget Submission to Congress
13 The Safety Net for Children: The Performance
of the Safety Net and Changes in Federal Spending on Child Well Being.
Sources: Steve Bantolome:-Hill, Allison Logie and Gary Hyzer.
U.S. Department of Health and Human Services, Office of Assistant
Secretary for Planning and Evaluation (Forth Coming)
14 Sources: Tesman, J. and Hills, A. (1994),
"Developmental Effects of Lead Exposure in Children," Social Policy
Report, 8(3); Environmental Health Threats to Children (1996), U.S.
Environmental Protection Agency, Office of the Administrator,
Washington, D.C.; Measuring Lead Exposure in Infants, Children, and
Other Sensitive Populations (1993), National Academy Press,
Washington, D.C.; U.S. Agency for Toxic Substances and Disease Registry
(1996), internal correspondence.
15 Additional examples of research questions can
be found in reports of the National Academy of Sciences/Institute of
Medicine, Board on Children and Families.
Appendix A: The Children's
Initiative - Principals
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